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Hutin A, Lamhaut L, Lidouren F, Kohlhauer M, Mongardon N, Carli P, Berdeaux A, Ghaleh B, Tissier R. Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs. J Am Heart Assoc 2016; 5:JAHA.116.004588. [PMID: 28007740 PMCID: PMC5210433 DOI: 10.1161/jaha.116.004588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Extracorporeal cardiopulmonary resuscitation (ECPR) is widely proposed for the treatment of refractory cardiac arrest. It should be associated with coronary angiography if coronary artery disease is suspected. However, the prioritization of care remains unclear in this situation. Our goal was to determine whether coronary reperfusion should be instituted as soon as possible in such situations in a pig model. Methods and Results Anesthetized pigs were instrumented and submitted to coronary artery occlusion and ventricular fibrillation. After 5 minutes of untreated cardiac arrest, conventional cardiopulmonary resuscitation (CPR) was started. Fifteen minutes later, ECPR was initiated for a total duration of 240 minutes. Animals randomly underwent either early or late coronary reperfusion at 20 or 120 minutes of ECPR, respectively. This timing was adapted to the kinetic of infarct extension in pigs. Return of spontaneous circulation was determined as organized electrocardiogram rhythm with systolic arterial pressure above 80 mm Hg. During conventional CPR, hemodynamic parameters were not different between groups. Carotid blood flow then increased by 70% after the onset of ECPR in both groups. No animal (0 of 7) elicited return of spontaneous circulation after late reperfusion versus 4 of 7 after early reperfusion (P=0.025). The hemodynamic parameters, such as carotid blood flow, were also improved in early versus late reperfusion groups (113±20 vs 43±17 mL/min after 240 minutes of ECPR, respectively; P=0.030), along with infarct size decrease (71±4% vs 84±2% of the risk zone, respectively; P=0.013). Conclusions Early reperfusion improved hemodynamic status and facilitated return of spontaneous circulation in a porcine model of ischemic cardiac arrest treated by ECPR.
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Affiliation(s)
- Alice Hutin
- Inserm, U955, Equipe 03, Créteil, France.,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.,Département d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, SAMU de Paris, Université Paris Descartes-Paris V, Paris, France
| | - Lionel Lamhaut
- Département d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, SAMU de Paris, Université Paris Descartes-Paris V, Paris, France
| | - Fanny Lidouren
- Inserm, U955, Equipe 03, Créteil, France.,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France
| | - Matthias Kohlhauer
- Inserm, U955, Equipe 03, Créteil, France.,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France
| | - Nicolas Mongardon
- Inserm, U955, Equipe 03, Créteil, France.,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.,Service d'Anesthésie et des Réanimations Chirurgicales, Réanimation Chirurgicale Cardio-vasculaire, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Pierre Carli
- Département d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, SAMU de Paris, Université Paris Descartes-Paris V, Paris, France
| | - Alain Berdeaux
- Inserm, U955, Equipe 03, Créteil, France.,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France
| | - Bijan Ghaleh
- Inserm, U955, Equipe 03, Créteil, France.,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France
| | - Renaud Tissier
- Inserm, U955, Equipe 03, Créteil, France .,Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.,Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France
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202
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Lazzeri C, Valente S, Peris A, Gensini GF. Editor’s Choice-Extracorporeal life support for out-of-hospital cardiac arrest: Part of a treatment bundle. EUROPEAN HEART JOURNAL: ACUTE CARDIOVASCULAR CARE 2016; 5:512-521. [DOI: 10.1177/2048872615585517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Serafina Valente
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Adriano Peris
- Anesthesia and Intensive Unit of Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Italy
| | - Gian Franco Gensini
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Italy
- Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Italy
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203
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Bougouin W, Aissaoui N, Combes A, Deye N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Karam N, Dumas F, Marijon E, Jouven X, Cariou A. Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane oxygenation: An observational study and propensity-score analysis. Resuscitation 2016; 110:126-132. [PMID: 27865776 DOI: 10.1016/j.resuscitation.2016.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock. METHODS Using a large regional registry, we focused on all CA admitted in ICU. Among those who developed a post-CA shock, prognostic was compared according to VA-ECMO use, using logistic regression and propensity score. Specific prognostic factors were identified among VA-ECMO patients. RESULTS Among 2988 patients admitted after CA, 1489 developed a post-CA shock, and were included. They were mostly male (68%), with mean age 63 years (SD=15). Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were discharged alive (25% in VA-ECMO group, 21% in control group, P=0.45). After adjustment for pre-hospital and in-hospital factors, survival did not differ among patients treated with VA-ECMO (OR for survival=0.9, 95%CI 0.4-2.3, P=0.84). After propensity-score matching, results were consistent. Among patients treated with VA-ECMO, initial arterial pH (OR=1.7 per 0.1 increase, 95%CI 1.0-2.8, P=0.04) and implantation of VA-ECMO over 24h after ROSC (OR=20.0, 95%CI 1.4-277.3, P=0.03) were associated with survival. CONCLUSIONS Post-CA shock is frequent and is associated with a high mortality rate. When used in selected patients, we observed that VA-ECMO could be an appropriate treatment.
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Affiliation(s)
- Wulfran Bougouin
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Nadia Aissaoui
- Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Medical ICU, Pompidou Hospital, APHP, Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, Paris, France
| | - Nicolas Deye
- Medical ICU, Lariboisière Hospital, AP-HP, Paris, France; INSERM U942, Paris, France
| | - Lionel Lamhaut
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; ICU and SAMU 75, Necker Enfants-Malades Hospital, Paris, France
| | - Daniel Jost
- Paris Sudden-Death-Expertise-Center, Paris, France; Paris Fire Brigade Emergency Dept., Paris, France
| | - Carole Maupain
- Cardiology Department, Pitié-Salpétrière Hospital, APHP, Paris, France
| | - Frankie Beganton
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Adrien Bouglé
- Human Histopathology and Animal Models Unit, Infection and Epidemiology Department, Institut Pasteur, Paris, France; Anesthesiology and Intensive Care, Institut de Cardiologie, Pitié-Salpétrière Hospital, Paris, France
| | - Nicole Karam
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Florence Dumas
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France
| | - Eloi Marijon
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Xavier Jouven
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Alain Cariou
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; Medical ICU, Cochin Hospital, AP-HP, Paris, France.
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204
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Benedek T, Popovici MM, Glogar D. Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition. ACTA ACUST UNITED AC 2016; 2:164-174. [PMID: 29967856 DOI: 10.1515/jccm-2016-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/20/2016] [Indexed: 12/14/2022]
Abstract
This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.
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Affiliation(s)
- Theodora Benedek
- University of Medicine and Pharmacy Tirgu Mures, Clinic of Cardiology, Tirgu Mures, Romania
| | - Monica Marton Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington, USA
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205
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Concealed resuscitation-related injuries as reversible cause of recurrent arrest following extracorporeal cardiopulmonary resuscitation. CAN J EMERG MED 2016; 19:404-409. [DOI: 10.1017/cem.2016.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractA life-threatening cardiopulmonary resuscitation (CPR)-related injury can cause recurrent arrest after return of circulation. Such injuries are difficult to identify during resuscitation, and their contribution to failed resuscitation can be missed given the limitations of conventional CPR. Extracorporeal cardiopulmonary resuscitation (ECPR), increasingly being considered for selected patients with potentially reversible etiology of arrest, may identify previously occult CPR-related injuries by restoring arterial pressure and flow. Herein, we describe two cases of severe CPR-related injuries contributing to recurrent arrest. Each case had ECPR implemented within 60 minutes of the start of CPR. After the presumed cardiac etiology had been addressed with percutaneous coronary intervention, life-threatening cardiovascular injuries with recurrent arrest were noted, and resuscitative thoracotomy was performed under ECPR. One patient survived to hospital discharge.ECPR may provide an opportunity to identify and correct severe resuscitation-related injuries causing recurrent arrest. Chest compression depth >6 cm, especially in older women, may contribute to these injuries.
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206
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Doñate Bertolín L, Torregrosa Puerta S, Montero Argudo JA. Asistencia mecánica circulatoria de corta duración. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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207
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Choi DH, Kim YJ, Ryoo SM, Sohn CH, Ahn S, Seo DW, Lim JY, Kim WY. Extracorporeal cardiopulmonary resuscitation among patients with out-of-hospital cardiac arrest. Clin Exp Emerg Med 2016; 3:132-138. [PMID: 27752631 PMCID: PMC5065341 DOI: 10.15441/ceem.16.145] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 05/31/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered as a rescue therapy for patients with refractory cardiac arrest. Identifying patients who might benefit from this potential life-saving procedure is crucial for implementation of ECPR. The objective of this study was to estimate the number of patients who fulfilled a hypothetical set of ECPR criteria and to evaluate the outcome of ECPR candidates treated with conventional cardiopulmonary resuscitation. METHODS We performed an observational study using data from a prospective registry of consecutive adults (≥18 years) with non-traumatic out-of-hospital cardiac arrest in a tertiary hospital between January 2011 and December 2015. We developed a hypothetical set of ECPR criteria including age ≤75 years, witnessed cardiac arrest, no-flow time ≤5 minutes, low-flow time ≤30 minutes, refractory arrest at emergency department >10 minutes, and no exclusion criteria. The primary endpoint was the proportion of good neurologic outcome of ECPR-eligible patients. RESULTS Of 568 out-of-hospital cardiac arrest cases, 60 cases (10.6%) fulfilled our ECPR criteria. ECPR was performed for 10 of 60 ECPR-eligible patients (16.7%). Three of the 10 patients with ECPR (30.0%), but only 2 of the other 50 patients without ECPR (4.0%) had a good neurologic outcome at 1 month. CONCLUSION ECPR implementation might be a rescue option for increasing the probability of survival in potentially hopeless but ECPR-eligible patients.
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Affiliation(s)
- Dae-Hee Choi
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Ahn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Yong Lim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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208
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Aktuelle Empfehlungen zum Basic/Advanced Life Support. Med Klin Intensivmed Notfmed 2016; 111:670-681. [DOI: 10.1007/s00063-016-0216-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/10/2016] [Accepted: 08/23/2016] [Indexed: 10/20/2022]
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209
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Ahn C, Kim W, Cho Y, Choi KS, Jang BH, Lim TH. Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis. Sci Rep 2016; 6:34208. [PMID: 27659306 PMCID: PMC5034223 DOI: 10.1038/srep34208] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/09/2016] [Indexed: 11/09/2022] Open
Abstract
We performed a meta-analysis to compare the impact of extracorporeal cardiopulmonary resuscitation (ECPR) to that of conventional cardiopulmonary resuscitation (CCPR) in adult patients who experience cardiac arrest of cardiac origin. A literature search was performed using criteria set forth in a predefined protocol. Report inclusion criteria were that ECPR was compared to CCPR in adult patients with cardiac arrest of cardiac origin, and that survival and neurological outcome data were available. Exclusion criteria were reports describing non-cardiac origin arrest, review articles, editorials, and nonhuman studies. The efficacies of ECPR and CCPR were compared in terms of survival and neurological outcome. A total of 38,160 patients from 7 studies were ultimately included. ECPR showed similar survival (odds ratio [OR] 2.26, 95% confidence interval [CI] 0.45-11.20) and neurologic outcomes (OR 3.14, 95% CI 0.66-14.85) to CCPR in out-of-hospital cardiac arrest patients. For in-hospital cardiac arrest (IHCA) patients, however, ECPR was associated with significantly better survival (OR 2.40, 95% CI 1.44-3.98) and neurologic outcomes (OR 2.63, 95% CI 1.38-5.02) than CCPR. Hence, ECPR may be more effective than CCPR as an adjuvant therapy for survival and neurologic outcome in cardiac-origin IHCA patients.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
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210
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Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, Cherpanath TGV, Driessen AHG, de Mol BAJM, Henriques JPS. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016; 42:1922-1934. [PMID: 27647331 PMCID: PMC5106498 DOI: 10.1007/s00134-016-4536-8] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Abstract
Purpose Veno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest and cardiogenic shock, to support both cardiac and pulmonary function. We performed a systematic review and meta-analysis of cohort studies comparing mortality in patients treated with and without ECLS support in the setting of refractory cardiac arrest and cardiogenic shock complicating acute myocardial infarction. Methods We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed updated to December 2015. Thirteen studies were included of which nine included cardiac arrest patients (n = 3098) and four included patients with cardiogenic shock after acute myocardial infarction (n = 235). Data were pooled by a Mantel-Haenzel random effects model and heterogeneity was examined by the I2 statistic. Results In cardiac arrest, the use of ECLS was associated with an absolute increase of 30 days survival of 13 % compared with patients in which ECLS was not used [95 % CI 6–20 %; p < 0.001; number needed to treat (NNT) 7.7] and a higher rate of favourable neurological outcome at 30 days (absolute risk difference 14 %; 95 % CI 7–20 %; p < 0.0001; NNT 7.1). Propensity matched analysis, including 5 studies and 438 patients (219 in both groups), showed similar results. In cardiogenic shock, ECLS showed a 33 % higher 30-day survival compared with IABP (95 % CI, 14–52 %; p < 0.001; NNT 13) but no difference when compared with TandemHeart/Impella (−3 %; 95 % CI −21 to 14 %; p = 0.70; NNH 33). Conclusions In cardiac arrest, the use of ECLS was associated with an increased survival rate as well as an increase in favourable neurological outcome. In the setting of cardiogenic shock there was an increased survival with ECLS compared with IABP. Electronic supplementary material The online version of this article (doi:10.1007/s00134-016-4536-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dagmar M Ouweneel
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jasper V Schotborgh
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Krischan D Sjauw
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - A E Engström
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Wim K Lagrand
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas G V Cherpanath
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine H G Driessen
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Bas A J M de Mol
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - José P S Henriques
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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211
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Banfi C, Pozzi M, Brunner ME, Rigamonti F, Murith N, Mugnai D, Obadia JF, Bendjelid K, Giraud R. Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques. J Thorac Dis 2016; 8:E875-E885. [PMID: 27747024 DOI: 10.21037/jtd.2016.09.25] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation. VA-ECMO could also be suggested as a rescue therapeutic option for refractory cardiac arrest. It showed promising results in the specific setting of in-hospital cardiac arrest and survival rates with good neurological outcome are reported between 20% and 40%. Conversely, there are contrasting data in the literature about survival after VA-ECMO for out-of-hospital cardiac arrest, as results are highly dependent on low-flow time. The aim of the present report is to offer an overview of different cannulation techniques of VA-ECMO.
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Affiliation(s)
- Carlo Banfi
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France
| | - Marie-Eve Brunner
- Intensive Care Service, Department of Anesthesiology, Intensive Care and Pharmacology
| | - Fabio Rigamonti
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Murith
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Damiano Mugnai
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France
| | - Karim Bendjelid
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland ;; Intensive Care Service, Department of Anesthesiology, Intensive Care and Pharmacology
| | - Raphaël Giraud
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland ;; Intensive Care Service, Department of Anesthesiology, Intensive Care and Pharmacology
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213
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 923] [Impact Index Per Article: 115.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Kim DH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Extracorporeal Cardiopulmonary Resuscitation: Predictors of Survival. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:273-9. [PMID: 27525236 PMCID: PMC4981229 DOI: 10.5090/kjtcs.2016.49.4.273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
Background The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR). Methods Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated. Results Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001). Conclusion These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients.
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Affiliation(s)
- Dong Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Abstract
PURPOSE OF REVIEW To provide a summary of the recent literature on clinical outcomes in adults with cardiac arrest, focusing on the impact of patient-specific factors in combination with cardio-pulmonary resuscitation (CPR) related, and postresuscitative-related factors. RECENT FINDINGS Cardiac arrest is a major cause of morbidity and mortality worldwide. Despite the use of conventional cardiopulmonary resuscitation, rates of return of spontaneous circulation and survival with minimal neurologic impairment remain low. A number of recent studies have examined the impact of patient-specific factors (duration of cardiac arrest, initial rhythm, age, premorbid states), CPR-related (the use of mechanical CPR, the use of impedance threshold device, vasopressors, extra-corporeal membrane oxygenation, active compression-decompression, and impedance threshold device), and postresuscitative-related factors (hypothermia, coronary angiography, hyperoxia, hyper/hypocapnia, mean arterial blood pressure) on cardiac arrest outcomes. SUMMARY Further studies, namely randomized controlled trials, assessing the impact of advanced therapies are warranted to evaluate their impact on survival and neurologic function in adults with cardiac arrest.
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Shimizu K, Ogura H. Is the 77.1 % rate of in-hospital mortality in patients receiving venoarterial extracorporeal membrane oxygenation really that high? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:202. [PMID: 27417697 PMCID: PMC4946148 DOI: 10.1186/s13054-016-1379-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan
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Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-Hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest: A Nationwide Database Study. Crit Care Med 2016; 44:488-95. [PMID: 26496447 DOI: 10.1097/ccm.0000000000001401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the change in provision of therapeutic hypothermia and coronary intervention (postresuscitation care) over time and to clarify the association between these provisions and in-hospital mortality in patients with out-of-hospital cardiac arrest. DESIGN A nationwide retrospective cohort study using multiple propensity score analyses. SETTING Japanese Diagnosis Procedure Combination inpatient database. PATIENTS Adult patients with cardiogenic out-of-hospital cardiac arrest related to ventricular fibrillation were identified from July to December in 2008-2012 (385 hospitals; n = 3,413). MEASUREMENTS AND MAIN RESULTS We evaluated the proportion of patients receiving postresuscitation care and all-cause mortality at 30 days after out-of-hospital cardiac arrest. The proportion of postresuscitation care provision increased significantly over the study period (Mantel-Haenszel trend test, p < 0.001). The overall 30-day mortality was 52.0% (1,774/3,413), and the crude 30-day mortality decreased significantly during the study period (p = 0.006). Logistic regression analysis showed significant associations between the fiscal years 2011 and 2012 and 30-day mortality (2011: odds ratio, 0.75; 95% CI, 0.57-0.98 and 2012: odds ratio, 0.61; 95% CI, 0.47-0.81). Multiple propensity score analysis incorporating postresuscitation care showed that 30-day mortality was significantly associated with postresuscitation care, and the significant associations between 30-day mortality and the years 2011 and 2012 were no longer observed (2011: odds ratio, 1.05; 95% CI, 0.82-1.3 and 2012: odds ratio, 0.95; 95% CI, 0.74-1.2). CONCLUSIONS The 30-day survival rate of adult patients with cardiogenic out-of-hospital cardiac arrest related to ventricular fibrillation improved significantly after 2010 in Japan. This improvement may be associated with an increase in postresuscitation care provision.
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Lee MJ, Rho TH, Kim H, Kang GH, Kim JS, Rho SG, Park HK, Oh DJ, Oh S, Wi J, Je S, Chung SP, Hwang SO. Part 3. Advanced cardiac life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin Exp Emerg Med 2016; 3:S17-S26. [PMID: 27752643 PMCID: PMC5052917 DOI: 10.15441/ceem.16.134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Tai Ho Rho
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Gu Hyun Kang
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - June Soo Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Gyun Rho
- Department of Emergency Medical Services, Sunmoon University, Asan, Korea
| | - Hyun Kyung Park
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Jin Oh
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sangmo Je
- Department of Emergency Medicine, CHA University College of Medicine, Seongnam, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Extracorporeal Life Support for Cardiopulmonary Resuscitation for Adults: Evolving Evidence. ASAIO J 2016; 62:364-9. [DOI: 10.1097/mat.0000000000000358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg 2016; 152:20-32. [DOI: 10.1016/j.jtcvs.2016.02.067] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/30/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
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Cirillo F, DeRobertis E, Hinkelbein J. Extracorporeal life support for refractory out-of-hospital cardiac arrest in adults. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thrombolytic-Enhanced Extracorporeal Cardiopulmonary Resuscitation After Prolonged Cardiac Arrest. Crit Care Med 2016; 44:e58-69. [PMID: 26488218 DOI: 10.1097/ccm.0000000000001305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the effects of the combination of extracorporeal cardiopulmonary resuscitation and thrombolytic therapy on the recovery of vital organ function after prolonged cardiac arrest. DESIGN Laboratory investigation. SETTING University laboratory. SUBJECTS Pigs. INTERVENTIONS Animals underwent 30-minute untreated ventricular fibrillation cardiac arrest followed by extracorporeal cardiopulmonary resuscitation for 6 hours. Animals were allocated into two experimental groups: t-extracorporeal cardiopulmonary resuscitation (t-ECPR) group, which received streptokinase 1 million units, and control extracorporeal cardiopulmonary resuscitation (c-ECPR), which did not receive streptokinase. In both groups, the resuscitation protocol included the following physiologic targets: mean arterial pressure greater than 70 mm Hg, cerebral perfusion pressure greater than 50 mm Hg, PaO2 150 ± 50 torr (20 ± 7 kPa), PaCO2 40 ± 5 torr (5 ± 1 kPa), and core temperature 33°C ± 1°C. Defibrillation was attempted after 30 minutes of extracorporeal cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS A cardiac resuscitability score was assessed on the basis of success of defibrillation, return of spontaneous heart beat, weanability from extracorporeal cardiopulmonary resuscitation, and left ventricular systolic function after weaning. The addition of thrombolytic to extracorporeal cardiopulmonary resuscitation significantly improved cardiac resuscitability (3.7 ± 1.6 in t-ECPR vs 1.0 ± 1.5 in c-ECPR). Arterial lactate clearance was higher in t-ECPR than in c-ECPR (40% ± 15% vs 18% ± 21%). At the end of the experiment, the intracranial pressure was significantly higher in c-ECPR than in t-ECPR. Recovery of brain electrical activity, as assessed by quantitative analysis of electroencephalogram signal, and ischemic neuronal injury on histopathologic examination did not differ between groups. Animals in t-ECPR group did not have increased bleeding complications, including intracerebral hemorrhages. CONCLUSIONS In a porcine model of prolonged cardiac arrest, t-ECPR improved cardiac resuscitability and reduced brain edema, without increasing bleeding complications. However, early electroencephalogram recovery and ischemic neuronal injury were not improved.
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Lee JJ, Han SJ, Kim HS, Hong KS, Choi HH, Park KT, Seo JY, Lee TH, Kim HC, Kim S, Lee SH, Hwang SM, Ha SO. Out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal membrane oxygenation: focus on survival rate and neurologic outcome. Scand J Trauma Resusc Emerg Med 2016; 24:74. [PMID: 27193212 PMCID: PMC4870801 DOI: 10.1186/s13049-016-0266-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/10/2016] [Indexed: 01/12/2023] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is a useful treatment for refractory out-of-hospital cardiac arrest (OHCA). However, little is known about the predictors of survival and neurologic outcome after ECMO. We analyzed our institution’s experience with ECMO for refractory OHCA and evaluated the predictors of survival and neurologic outcome after ECMO. Methods This was a retrospective review of the medical records of 23 patients who were treated with ECMO due to OHCA that was unresponsive to conventional cardiopulmonary resuscitation, between January 2009 and January 2014. Results Our ECMO team was activated within 10 min for refractory OHCA, and the 30-day survival rate was 43.5 %. In a multivariate analysis that evaluated independent factors contributing to mortality, urine output ≤ 0.5 mL · kg−1 · h−1 (defined as oliguria) during the 24 h after ECMO was statistically significant (OR, 32.271; 95 % CI, 1.379–755.282; p = 0.031). Just after ECMO implantation, 6 of the 9 patients (66.7 %) who had normal findings on brain computed tomography (CT) survived with a cerebral performance category (CPC) of grade 1. However, only 3 of the 11 patients (27 %) who had evidence of hypoxic brain damage on initial brain CT survived (their CPC grade was 4). Conclusions Based on our findings, the survival rate can be improved by rapid implantation of ECMO, and oliguria seen during the first 24 h after ECMO may be an independent predictor of mortality. Furthermore, findings on brain CT just after ECMO and subsequent images may represent an important predictor for neurologic outcome after ECMO.
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Affiliation(s)
- Jae Jun Lee
- Department of Anesthesiology, Hallym University Medical Center, Chuncheon, South Korea
| | - Sang Jin Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea
| | - Hyoung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
| | - Kyung Soon Hong
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea
| | - Hyun Hee Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea
| | - Kyu Tae Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea
| | - Jeong Yeol Seo
- Department of Emergency Medicine, Hallym University Medical Center, Chuncheon, South Korea
| | - Tae Hun Lee
- Department of Emergency Medicine, Hallym University Medical Center, Chuncheon, South Korea
| | - Heung Cheol Kim
- Department of Radiology, Hallym University Medical Center, Chuncheon, South Korea
| | - Seonju Kim
- Department of Anesthesiology, Hallym University Medical Center, Chuncheon, South Korea
| | - Sun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Sung Mi Hwang
- Department of Anesthesiology, Hallym University Medical Center, Chuncheon, South Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Medical Center, Chuncheon, South Korea
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Atkinson TM, Ohman EM, O’Neill WW, Rab T, Cigarroa JE. A Practical Approach to Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2016; 9:871-83. [DOI: 10.1016/j.jcin.2016.02.046] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
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Ortega-Deballon I, Hornby L, Shemie SD, Bhanji F, Guadagno E. Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: A systematic review of international practices and outcomes. Resuscitation 2016; 101:12-20. [DOI: 10.1016/j.resuscitation.2016.01.018] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/05/2015] [Accepted: 01/21/2016] [Indexed: 11/27/2022]
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Grunau B, Reynolds J, Scheuermeyer F, Stenstom R, Stub D, Pennington S, Cheskes S, Ramanathan K, Christenson J. Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital? PREHOSP EMERG CARE 2016; 20:615-22. [PMID: 27018764 DOI: 10.3109/10903127.2016.1149652] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Extracorporeal cardiopulmonary resuscitation (ECPR) may improve outcomes for refractory out-of-hospital cardiac arrest (OHCA). Transport of intra-arrest patients to hospital however, may decrease CPR quality, potentially reducing survival for those who would have achieved return-of-spontaneous-circulation (ROSC) with further on-scene resuscitation. We examined time-to-ROSC and patient outcomes for the optimal time to consider transport. METHODS From a prospective registry of consecutive adult non-traumatic OHCA's, we identified a hypothetical ECPR-eligible cohort of EMS-treated patients with age ≤ 65, witnessed arrest, and bystander CPR or EMS arrival < 10 minutes. We assessed the relationship between time-to-ROSC and survival, and constructed a ROC curve to illustrate the ability of a pulseless state to predict non-survival with conventional resuscitation. RESULTS Of 6,571 EMS-treated cases, 1,206 were included with 27% surviving. Increasing time-to-ROSC (per minute) was negatively associated with survival (adjusted OR 0.91; 95%CI 0.89-0.93%). The yield of survivors per minute of resuscitation increased from commencement and started to decline in the 8th minute. Fifty percent and 90% of survivors had achieved ROSC by 8.0 and 24 min, respectively, at which times the probability of survival for those with initial shockable rhythms was 31% and 10%, and for non-shockable rhythms was 5.2% and 1.6%. The ROC curve illustrated that the 16th minute of resuscitation maximized sensitivity and specificity (AUC = 0.87, 95% CI 0.85-0.89). CONCLUSION Transport for ECPR should be considered between 8 to 24 minutes of professional on-scene resuscitation, with 16 minutes balancing the risks and benefits of early and later transport. Earlier transport within this window may be preferred if high quality CPR can be maintained during transport and for those with initial non-shockable rhythms.
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Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest. CAN J EMERG MED 2016; 18:453-460. [PMID: 26940662 DOI: 10.1017/cem.2016.8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. METHODS We performed a secondary analysis from a 52-month prospective registry of consecutive adult non-traumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge. RESULTS Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge. CONCLUSION In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.
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Kim SJ, Kim HJ, Lee HY, Ahn HS, Lee SW. Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis. Resuscitation 2016; 103:106-116. [PMID: 26851058 DOI: 10.1016/j.resuscitation.2016.01.019] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/19/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objective was to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), when compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients, and to determine appropriate conditions that can predict good survival outcome in ECPR patients through a meta-analysis. METHODS We searched the relevant literature of comparative studies between ECPR and CCPR in adults, from the MEDLINE, EMBASE, and Cochrane databases. The baseline information and outcome data (survival, good neurologic outcome at discharge, at 3-6 months, and at 1 year after arrest) were extracted. Beneficial effect of ECPR on outcome was analyzed according to time interval, location of arrest (out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA)), and pre-defined population inclusion criteria (witnessed arrest, initial shockable rhythm, cardiac etiology of arrest and CPR duration) by using Review Manager 5.3. Cochran's Q test and I(2) were calculated. RESULTS 10 of 1583 publications were included. Although survival to discharge did not show clear superiority in OHCA, ECPR showed statistically improved survival and good neurologic outcome as compared to CCPR, especially at 3-6 months after arrest. In the subgroup of patients with pre-defined inclusion criteria, the pooled meta-analysis found similar results in studies with pre-defined criteria. CONCLUSION Survival and good neurologic outcome tended to be superior in the ECPR group at 3-6 months after arrest. The effect of ECPR on survival to discharge in OHCA was not clearly shown. As ECPR showed better outcomes than CCPR in studies with pre-defined criteria, strict indications criteria should be considered when implementation of ECPR.
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Affiliation(s)
- Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University Hospital, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyeong Sik Ahn
- Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, College of Medicine, Korea University Hospital, Seoul, Republic of Korea.
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Lee YH, Oh YT, Ahn HC, Kim HS, Han SJ, Lee JJ, Lee TH, Seo JY, Shin DH, Ha SO, Park SO. The prognostic value of the grey-to-white matter ratio in cardiac arrest patients treated with extracorporeal membrane oxygenation. Resuscitation 2016; 99:50-5. [DOI: 10.1016/j.resuscitation.2015.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 10/30/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
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Choi DS, Kim T, Ro YS, Ahn KO, Lee EJ, Hwang SS, Song SW, Song KJ, Shin SD. Extracorporeal life support and survival after out-of-hospital cardiac arrest in a nationwide registry: A propensity score-matched analysis. Resuscitation 2016; 99:26-32. [DOI: 10.1016/j.resuscitation.2015.11.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/06/2015] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
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Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience. Int J Cardiol 2016; 204:70-6. [DOI: 10.1016/j.ijcard.2015.11.165] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/09/2015] [Accepted: 11/22/2015] [Indexed: 11/17/2022]
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Mancini ME, Diekema DS, Hoadley TA, Kadlec KD, Leveille MH, McGowan JE, Munkwitz MM, Panchal AR, Sayre MR, Sinz EH. Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S383-96. [PMID: 26472991 DOI: 10.1161/cir.0000000000000254] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O'Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J. Part 4: Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S84-145. [PMID: 26472860 DOI: 10.1161/cir.0000000000000273] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S444-64. [PMID: 26472995 DOI: 10.1161/cir.0000000000000261] [Citation(s) in RCA: 800] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lasa JJ, Rogers RS, Localio R, Shults J, Raymond T, Gaies M, Thiagarajan R, Laussen PC, Kilbaugh T, Berg RA, Nadkarni V, Topjian A. Extracorporeal Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest Is Associated With Improved Survival to Discharge: A Report from the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) Registry. Circulation 2016; 133:165-76. [PMID: 26635402 PMCID: PMC4814337 DOI: 10.1161/circulationaha.115.016082] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although extracorporeal cardiopulmonary resuscitation (E-CPR) can result in survival after failed conventional CPR (C-CPR), no large, systematic comparison of pediatric E-CPR and continued C-CPR has been reported. METHODS AND RESULTS Consecutive patients <18 years old with CPR events ≥10 minutes in duration reported to the Get With the Guidelines-Resuscitation registry between January 2000 and December 2011 were identified. Hospitals were grouped by teaching status and location. Primary outcome was survival to discharge. Regression modeling was performed, conditioning on hospital groups. A secondary analysis was performed with the use of propensity score matching. Of 3756 evaluable patients, 591 (16%) received E-CPR and 3165 (84%) received C-CPR only. Survival to hospital discharge and survival with favorable neurological outcome (Pediatric Cerebral Performance Category score of 1-3 or unchanged from admission) were greater for E-CPR (40% [237 of 591] and 27% [133 of 496]) versus C-CPR patients (27% [862 of 3165] and 18% [512 of 2840]). Odds ratios (ORs) for survival to hospital discharge and survival with favorable neurological outcome were greater for E-CPR versus C-CPR. After adjustment for covariates, patients receiving E-CPR had higher odds of survival to discharge (OR, 2.80; 95% confidence interval, 2.13-3.69; P<0.001) and survival with favorable neurological outcome (OR, 2.64; 95% confidence interval, 1.91-3.64; P<0.001) than patients who received C-CPR. This association persisted when analyzed by propensity score-matched cohorts (OR, 1.70; 95% confidence interval, 1.33-2.18; P<0.001; and OR, 1.78; 95% confidence interval, 1.31-2.41; P<0.001, respectively]. CONCLUSION For children with in-hospital CPR of ≥10 minutes duration, E-CPR was associated with improved survival to hospital discharge and survival with favorable neurological outcome compared with C-CPR.
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Affiliation(s)
- Javier J Lasa
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.).
| | - Rachel S Rogers
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Russell Localio
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Justine Shults
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Tia Raymond
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Michael Gaies
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Ravi Thiagarajan
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Peter C Laussen
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Todd Kilbaugh
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Robert A Berg
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Vinay Nadkarni
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Alexis Topjian
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
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Rousse N, Robin E, Juthier F, Hysi I, Banfi C, Al Ibrahim M, Coadou H, Goldstein P, Wiel E, Vincentelli A. Extracorporeal Life Support in Out-of-Hospital Refractory Cardiac Arrest. Artif Organs 2015; 40:904-9. [DOI: 10.1111/aor.12655] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Natacha Rousse
- Department of Cardiovascular Surgery; Centre Hospitalier Regional et Universitaire de Lille; Lille France
| | - Emmanuel Robin
- Department of Anesthesiology; Centre Hospitalier Regional et Universitaire de Lille; Lille France
| | - Francis Juthier
- Department of Cardiovascular Surgery; Centre Hospitalier Regional et Universitaire de Lille; Lille France
| | - Ilir Hysi
- Department of Cardiovascular Surgery; Centre Hospitalier Regional et Universitaire de Lille; Lille France
| | - Carlo Banfi
- Department of Cardiovascular Surgery; Centre Hospitalier Regional et Universitaire de Lille; Lille France
| | - Merie Al Ibrahim
- Department of Cardiovascular Surgery; Centre Hospitalier Regional et Universitaire de Lille; Lille France
| | - Herve Coadou
- Department of SAMU; Centre Hospitalier Regional et Universitaire de Lille; Lille France
- Université Lille Nord de France; Inserm UMR1011 & UDSL; Institut Pasteur de Lille; EGID; Lille France
| | - Patrick Goldstein
- Department of SAMU; Centre Hospitalier Regional et Universitaire de Lille; Lille France
- Université Lille Nord de France; Inserm UMR1011 & UDSL; Institut Pasteur de Lille; EGID; Lille France
| | - Eric Wiel
- Department of SAMU; Centre Hospitalier Regional et Universitaire de Lille; Lille France
- Université Lille Nord de France; Inserm UMR1011 & UDSL; Institut Pasteur de Lille; EGID; Lille France
| | - Andre Vincentelli
- Department of Cardiovascular Surgery; Centre Hospitalier Regional et Universitaire de Lille; Lille France
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Mosier JM, Kelsey M, Raz Y, Gunnerson KJ, Meyer R, Hypes CD, Malo J, Whitmore SP, Spaite DW. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:431. [PMID: 26672979 PMCID: PMC4699333 DOI: 10.1186/s13054-015-1155-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.
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Affiliation(s)
- Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, Tucson, AZ, 85724, USA. .,Arizona Emergency Medicine Research Center, University of Arizona, 1609 N. Warren Ave, Tucson, AZ, 85724, USA. .,Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85721, USA.
| | - Melissa Kelsey
- Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, Tucson, AZ, 85724, USA
| | - Yuval Raz
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85721, USA
| | - Kyle J Gunnerson
- Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Robyn Meyer
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85721, USA
| | - Cameron D Hypes
- Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, Tucson, AZ, 85724, USA.,Arizona Emergency Medicine Research Center, University of Arizona, 1609 N. Warren Ave, Tucson, AZ, 85724, USA.,Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85721, USA
| | - Josh Malo
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85721, USA
| | - Sage P Whitmore
- Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Daniel W Spaite
- Arizona Emergency Medicine Research Center, University of Arizona, 1609 N. Warren Ave, Tucson, AZ, 85724, USA
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Patroniti N, Sangalli F, Avalli L. Post-cardiac arrest extracorporeal life support. Best Pract Res Clin Anaesthesiol 2015; 29:497-508. [DOI: 10.1016/j.bpa.2015.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 01/19/2023]
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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242
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 537] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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Soar J, Callaway CW, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O’Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J, Andersen LW, Berg KM, Sandroni C, Lin S, Lavonas EJ, Golan E, Alhelail MA, Chopra A, Cocchi MN, Cronberg T, Dainty KN, Drennan IR, Fries M, Geocadin RG, Gräsner JT, Granfeldt A, Heikal S, Kudenchuk PJ, Lagina AT, Løfgren B, Mhyre J, Monsieurs KG, Mottram AR, Pellis T, Reynolds JC, Ristagno G, Severyn FA, Skrifvars M, Stacey WC, Sullivan J, Todhunter SL, Vissers G, West S, Wetsch WA, Wong N, Xanthos T, Zelop CM, Zimmerman J. Part 4: Advanced life support. Resuscitation 2015; 95:e71-120. [DOI: 10.1016/j.resuscitation.2015.07.042] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abrams D, Brodie D. Novel Uses of Extracorporeal Membrane Oxygenation in Adults. Clin Chest Med 2015; 36:373-84. [DOI: 10.1016/j.ccm.2015.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jung C, Janssen K, Kaluza M, Fuernau G, Poerner TC, Fritzenwanger M, Pfeifer R, Thiele H, Figulla HR. Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation. Clin Res Cardiol 2015; 105:196-205. [PMID: 26303097 DOI: 10.1007/s00392-015-0906-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiac arrest is the major cause of sudden death in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) employs extracorporeal membrane oxygenation (ECMO) in patients without return of spontaneous circulation (ROSC) by conventional cardiopulmonary resuscitation (CPR). Aim of the current study was to assess short- and long-term outcome in patients treated with ECPR in our tertiary center and to identify predictors of outcome. METHODS We retrospectively collected data of all patients treated with ECPR at our institution from 2002 to 2013. Outcome was assessed according to patient records; good neurological outcome was defined as cerebral performance category 1 or 2. Quality of life data was collected using EQ-5 questionnaire. Uni- and multivariate analysis was applied to identify predictors of outcome. RESULTS One-hundred and seventeen patients were included into the study. Weaning from ECMO was successful in 61 (52 %) patients. Thirty-day survival endpoint was achieved by 27 (23 %) patients. Good neurological outcome was present in 17 (15 %) patients. Multivariate analysis revealed baseline serum lactate as the strongest predictor of outcome, whereas age and out-of-hospital CPR did not predict outcome. The optimal lactate cut-off to discriminate outcome was determined at 4.6 mmol/l [HR 3.55 (2.29-5.49), p < 0.001, log-rank test]. CONCLUSION ECPR represents a treatment option in patients without ROSC after conventional CPR rescuing 15 % of patients with good neurological outcome. Serum lactate may play a crucial role in patient selection for ECPR.
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Affiliation(s)
- Christian Jung
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Kyra Janssen
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Mirko Kaluza
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
| | - Georg Fuernau
- Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany.
| | - Tudor Constantin Poerner
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Michael Fritzenwanger
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Ruediger Pfeifer
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Holger Thiele
- Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany.
| | - Hans Reiner Figulla
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
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Kim KI, Lee HS, Kim HS, Ha SO, Lee WY, Park SJ, Lee SH, Lee TH, Seo JY, Choi HH, Park KT, Han SJ, Hong KS, Hwang SM, Lee JJ. The pre-ECMO simplified acute physiology score II as a predictor for mortality in patients with initiation ECMO support at the emergency department for acute circulatory and/or respiratory failure: a retrospective study. Scand J Trauma Resusc Emerg Med 2015; 23:59. [PMID: 26283075 PMCID: PMC4538750 DOI: 10.1186/s13049-015-0135-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/14/2015] [Indexed: 12/27/2022] Open
Abstract
Background In the emergency department (ED), extracorporeal membrane oxygenation (ECMO) can be used as a rescue treatment modality for patients with refractory circulatory and/or respiratory failure. Serious consideration must be given to the indication, and the PRESERVE and RESP scores for mortality have been investigated. However these scores were validated to predict survival in patients who received mainly veno-venous (VV) ECMO in the intensive care unit. The aim of the present study was to investigate the factors that predicted the outcomes for patients who received mixed mode (veno-arterial [VA] and VV) ECMO support in the ED. Methods This single center retrospective study included 65 patients who received ECMO support at the ED for circulatory or respiratory failure between January 2009 and December 2013. Pre-ECMO SAPS II and other variables were evaluated and compared for predicting mortality. Results Fifty-four percent of patients received ECMO-cardiopulmonary resuscitation (E-CPR), 31 % received VA and V-AV ECMO, and 15 % received VV ECMO. The 28-day and 60-month mortality rates were 52 % and 63 %. In the multivariate analysis, only the pre-ECMO Simplified Acute Physiology Score II (SAPS II) (odd ratio: 1.189, 95 % confidence interval: 1.032–1.370, p = 0.016) could predict the 28-day mortality. The area under the receiver operating characteristic curve and the optimal cutoff value for pre-ECMO SAPS II in predicting 28-day mortality was 0.852 (95 % CI: 0.753–0.951, p < 0.001) and 80 (sensitivity of 97.1 % and specificity of 71.0 %), respectively. Validation of the 80 cutoff value revealed a statistically significant difference for the 28-day and 60-month mortality rates in the overall, E-CPR, and VA groups (28-day: p < 0.001, p = 0.004, p = 0.005; 60-month: p < 0.001, p = 0.004, p = 0.020). In the Kaplan-Meier analysis, the 28-day and 60-month survival rates were lower among the patients with a pre-ECMO SAPS II of ≤80, compared to those with a score of >80 (both, p < 0.001). Conclusion The pre-ECMO SAPS II could be helpful for identifying patients with refractory acute circulatory and/or respiratory failure who will respond to ECMO support in the ED.
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Affiliation(s)
- Kun Il Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, 22, Gwanpyeong-ro 170 beon-gil, Donan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
| | - Hee Sung Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, 22, Gwanpyeong-ro 170 beon-gil, Donan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
| | - Hyoung Soo Kim
- Department of Emergency Medicine, Hallym University Medical Center, Kyoungki-do, South Korea.
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University, Chuncheon, South Korea.
| | - Won Yong Lee
- Department of Emergency Medicine, Hallym University Medical Center, Kyoungki-do, South Korea.
| | - Sang Jun Park
- Department of Emergency Medicine, Hallym University Medical Center, Kyoungki-do, South Korea.
| | - Sun Hee Lee
- Department of Emergency Medicine, Hallym University Medical Center, Kyoungki-do, South Korea.
| | - Tae Hun Lee
- Division of Cardiology, Department of Internal Medicine, Hallym University, Chuncheon, South Korea.
| | - Jeong Yeol Seo
- Division of Cardiology, Department of Internal Medicine, Hallym University, Chuncheon, South Korea.
| | - Hyun Hee Choi
- Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, South Korea.
| | - Kyu Tae Park
- Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, South Korea.
| | - Sang Jin Han
- Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, South Korea.
| | - Kyung Soon Hong
- Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, South Korea.
| | - Sung Mi Hwang
- Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, South Korea.
| | - Jae Jun Lee
- Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, South Korea.
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247
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Schmidt M, Bréchot N, Combes A. Ten situations in which ECMO is unlikely to be successful. Intensive Care Med 2015; 42:750-752. [PMID: 26271905 DOI: 10.1007/s00134-015-4013-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/05/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Matthieu Schmidt
- Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Nicolas Bréchot
- Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - Alain Combes
- Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
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248
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Pichler P, Antretter H, Dünser M, Eschertzhuber S, Gottardi R, Heinz G, Pölzl G, Pretsch I, Rajek A, Wasler A, Zimpfer D, Geppert A. Positionspapier der Österreichischen Kardiologischen Gesellschaft zum Einsatz der extrakorporalen Membranoxygenation (ECMO) bei Erwachsenen kardiologischen Patienten. Med Klin Intensivmed Notfmed 2015. [DOI: 10.1007/s00063-015-0052-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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249
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Kippnich M, Lotz C, Kredel M, Schimmer C, Weismann D, Sommer C, Kranke P, Roewer N, Muellenbach R. Venoarterielle extrakorporale Membranoxygenierung beim präklinischen Herz-Kreislauf-Stillstand. Anaesthesist 2015; 64:580-5. [DOI: 10.1007/s00101-015-0058-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 06/12/2015] [Indexed: 01/10/2023]
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250
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Bednarczyk JM, Singal RK. Functional outcomes after resuscitative extracorporeal membrane oxygenation for cardiac arrest: The patients speak for themselves. J Thorac Cardiovasc Surg 2015; 150:955-6. [PMID: 26190657 DOI: 10.1016/j.jtcvs.2015.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Joseph M Bednarczyk
- Section of Critical Care, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Rohit K Singal
- Section of Critical Care, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Surgical Heart Failure Program, Section of Cardiac Surgery, Department of Surgery, University of Manitoba, St Boniface General Hospital, Winnipeg, Manitoba, Canada
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