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Olson TL, Kilcoyne HW, Morales-Demori R, Rycus P, Barbaro RP, Alexander PMA, Anders MM. Extracorporeal cardiopulmonary resuscitation for pediatric out-of-hospital cardiac arrest: A review of the Extracorporeal Life Support Organization Registry. Resuscitation 2024; 203:110380. [PMID: 39222833 DOI: 10.1016/j.resuscitation.2024.110380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
AIMS Current data are insufficient for the leading resuscitation societies to advise on the use of extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to explore the current utilization of ECPR for pediatric OHCA and characterize the patient demographics, arrest features, and metabolic parameters associated with survival. METHODS Retrospective review of the Extracorporeal Life Support Organization Registry database from January 2020 to May 2023, including children 28 days to 18 years old who received ECPR for OHCA. The primary outcome was survival to hospital discharge. RESULTS Eighty patients met inclusion criteria. Median age was 8.8 years [2.0-15.8] and 53.8% of patients were male. OHCA was witnessed for 65.0% of patients and 46.3% received bystander cardiopulmonary resuscitation (CPR). Initial rhythm was shockable in 26.3% of patients and total CPR duration was 78 min [52-106]. Signs of life were noted for 31.3% of patients and a cardiac etiology precipitating event was present in 45.0%. Survival to discharge was 29.9%. Initial shockable rhythm was associated with increased odds of survival (unadjusted OR 4.7 [1.5-14.5]; p = 0.006), as were signs of life prior to ECMO (unadjusted OR 7.8 [2.6-23.4]; p < 0.001). Lactate levels early on-ECMO (unadjusted OR 0.89 [0.79-0.99]; p = 0.02) and at 24 h on-ECMO (unadjusted OR 0.62 [0.42-0.91]; p < 0.001) were associated with decreased odds of survival. CONCLUSIONS These preliminary data suggest that while overall survival is poor, a carefully selected pediatric OHCA patient may benefit from ECPR. Further studies are needed to understand long-term neurologic outcomes.
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Affiliation(s)
- Taylor L Olson
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Hannah W Kilcoyne
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Raysa Morales-Demori
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA.
| | - Peter Rycus
- Extracorporeal Life Support Organization, 3001 Miller Road, Ann Arbor, MI, USA.
| | - Ryan P Barbaro
- Department of Pediatrics, Division of Critical Care Medicine, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA.
| | - Peta M A Alexander
- Department of Pediatrics, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA.
| | - Marc M Anders
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA.
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Billig H, Al Zaidi M, Quacken F, Görtzen-Patin J, Goody PR, Gräff I, Nickenig G, Zimmer S, Aksoy A. Blood glucose and lactate levels as early predictive markers in patients presenting with cardiogenic shock: A retrospective cohort study. PLoS One 2024; 19:e0306107. [PMID: 39052641 PMCID: PMC11271948 DOI: 10.1371/journal.pone.0306107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/11/2024] [Indexed: 07/27/2024] Open
Abstract
Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.
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Affiliation(s)
- Hannah Billig
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | | | - Florian Quacken
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | | | | | - Ingo Gräff
- Department of clinical acute- and emergency medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
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3
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Jeong YH, Lim SK, Cho Y, Kim YJ, Jang HJ, Cho YH, Shin Y, Jung JS, Kang JK, Cho SM, Lee JH. Neuron-Specific Enolase as a Predictor of Neurologic Outcomes in Extracorporeal Cardiopulmonary Resuscitation Patients. J Clin Med 2024; 13:4135. [PMID: 39064175 PMCID: PMC11277770 DOI: 10.3390/jcm13144135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/12/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Neuron-specific enolase (NSE) has traditionally been used as a biomarker to predict neurologic outcomes after cardiac arrest. This study aimed to evaluate the utility of NSE in predicting neurologic outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This observational cohort study included 47 consecutive adult ECPR patients (median age, 59.0 years; 74.5% males) treated between January 2018 and December 2021 at a tertiary extracorporeal life support center. The primary outcome was a poor neurologic outcome, defined as a Cerebral Performance Category score of 3-5 at hospital discharge. Results: Twelve (25.5%) patients had abnormal findings on computed tomography of the brain. A poor neurologic outcome was demonstrated in 22 (46.8%) patients. The NSE level at 72 h after ECPR showed the best prediction power for a poor neurologic outcome compared with NSE at 24 and 48 h. A cutoff value exceeding 61.9 μg/L for NSE at 72 h yielded an area under the curve (AUC) of 0.791 for predicting poor neurologic outcomes and exceeding 62.1 μg/L with an AUC of 0.838 for 30-day mortality. Conclusions: NSE levels at 72 h after ECPR appear to be a reliable biomarker for predicting poor neurologic outcomes and 30-day mortality in ECPR patients.
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Affiliation(s)
- Yong Ho Jeong
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Suk Kyung Lim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul 06351, Republic of Korea; (S.K.L.); (Y.H.C.)
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
| | - Yun Jin Kim
- Department of Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea;
- Biostatistics Lab, Medical Research Collaborating Center, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyo Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul 06351, Republic of Korea; (S.K.L.); (Y.H.C.)
| | - Yonghoon Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (Y.S.); (J.S.J.)
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (Y.S.); (J.S.J.)
| | - Jin Kook Kang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (Y.S.); (J.S.J.)
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4
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Bernard S, Pashun RA, Varma B, Yuriditsky E. Physiology-Guided Resuscitation: Monitoring and Augmenting Perfusion during Cardiopulmonary Arrest. J Clin Med 2024; 13:3527. [PMID: 38930056 PMCID: PMC11205151 DOI: 10.3390/jcm13123527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Given the high morbidity and mortality associated with cardiopulmonary arrest, there have been multiple trials aimed at better monitoring and augmenting coronary, cerebral, and systemic perfusion. This article aims to elucidate these interventions, first by detailing the physiology of cardiopulmonary resuscitation and the available tools for managing cardiopulmonary arrest, followed by an in-depth examination of the newest advances in the monitoring and delivery of advanced cardiac life support.
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Affiliation(s)
| | | | | | - Eugene Yuriditsky
- Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA; (S.B.); (R.A.P.)
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Ubben JF, Heuts S, Delnoij TS, Suverein MM, Hermanides RC, Otterspoor LC, Kraemer CVE, Vlaar AP, van der Heijden JJ, Scholten E, den Uil C, Dos Reis Miranda D, Akin S, de Metz J, van der Horst IC, Winkens B, Maessen JG, Lorusso R, van de Poll MC. Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial. Resusc Plus 2024; 18:100657. [PMID: 38778803 PMCID: PMC11108965 DOI: 10.1016/j.resplu.2024.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a supportive treatment for refractory out-of-hospital cardiac arrest (OHCA). Still, there is a paucity of data evaluating favorable and unfavorable prognostic characteristics in patients considered for ECPR. Methods We performed a previously unplanned post-hoc analysis of the multicenter randomized controlled INCEPTION-trial. The study group consisted of patients receiving ECPR, irrespective of initial group randomization. The patients were divided into favorable survivors (cerebral performance category [CPC] 1-2) and unfavorable or non-survivors (CPC 3-5). Results In the initial INCEPTION-trial, 134 patients were randomized. ECPR treatment was started in 46 (66%) of 70 patients in the ECPR treatment arm and 3 (4%) of 74 patients in the conventional treatment arm. No statistically significant differences in baseline characteristics, medical history, or causes of arrest were observed between survivors (n = 5) and non-survivors (n = 44). More patients in the surviving group had a shockable rhythm at the time of cannulation (60% vs. 14%, p = 0.037), underwent more defibrillation attempts (13 vs. 6, p = 0.002), and received higher dosages of amiodarone (450 mg vs 375 mg, p = 0.047) despite similar durations of resuscitation maneuvers. Furthermore, non-survivors more frequently had post-ECPR implantation adverse events. Conclusion The persistence of ventricular arrhythmia is a favorable prognostic factor in patients with refractory OHCA undergoing an ECPR-based treatment. Future studies are warranted to confirm this finding and to establish additional prognostic factors.Clinical trial Registration:clinicaltrials.gov registration number NCT03101787.
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Affiliation(s)
- Johannes F.H. Ubben
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Samuel Heuts
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Thijs S.R. Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Martje M. Suverein
- Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | | | - Luuk C. Otterspoor
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Carlos V. Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander P.J. Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joris J. van der Heijden
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erik Scholten
- Department of Intensive Care Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Corstiaan den Uil
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Intensive Care Medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sakir Akin
- Department of Intensive Care Medicine, Haga Ziekehuis, The Hague, the Netherlands
| | - Jesse de Metz
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Iwan C.C. van der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Jos G. Maessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Marcel C.G. van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Brodska H, Smalcova J, Kavalkova P, Lavage DR, Dusik M, Belohlavek J, Drabek T. Biomarkers for neuroprognostication after standard versus extracorporeal cardiopulmonary resuscitation - A sub-analysis of Prague-OHCA study. Resuscitation 2024; 199:110219. [PMID: 38649087 DOI: 10.1016/j.resuscitation.2024.110219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Limited evidence exists for prognostic performance of biomarkers in patients resuscitated from out-of-hospital cardiac arrest (OHCA) with extracorporeal CPR (ECPR). We hypothesized that (1) the time course and (2) prognostic performance of biomarkers might differ between CPR and ECPR in a sub-analysis of Prague-OHCA study. METHODS Patients received either CPR (n = 164) or ECPR (n = 92). The primary outcome was favorable neurologic survival at 180 days [cerebral performance category (CPC) 1-2]. Secondary outcomes included biomarkers of neurologic injury, inflammation and hemocoagulation. RESULTS Favorable neurologic outcome was not different between groups: CPR 29.3% vs. ECPR 21.7%; p = 0.191. Biomarkers exhibited similar trajectories in both groups, with better values in patients with CPC 1-2. Procalcitonin (PCT) was higher in ECPR group at 24-72 h (all p < 0.01). Neuron-specific enolase (NSE), C-reactive protein and neutrophil-to-lymphocyte ratio did not differ between groups. Platelets, D-dimers and fibrinogen were lower in ECPR vs. CPR groups at 24-72 h (all p < 0.001). ROC analysis (24-48-72 h) showed the best performance of NSE in both CPR and ECPR groups (AUC 0.89 vs. 0.78; 0.9 vs. 0.9; 0.91 vs. 0.9). PCT showed good performance specifically in ECPR (0.72 vs. 0.84; 0.73 vs. 0.87; 0.73 vs. 0.86). Optimal cutoff points of NSE and PCT were higher in ECPR vs. CPR. CONCLUSIONS Biomarkers exhibited similar trajectories although absolute values tended to be higher in ECPR. NSE had superior performance in both groups. PCT showed a good performance specifically in ECPR. Additional biomarkers may have modest incremental value. Prognostication algorithms should reflect the resuscitation method.
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Affiliation(s)
- Helena Brodska
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 499/2, 128 08 Prague, Czech Republic
| | - Jana Smalcova
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Katerinska 32, Prague, Czech Republic; Emergency Medical Service in Prague, Korunni 98, Prague, Czech Republic
| | - Petra Kavalkova
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 499/2, 128 08 Prague, Czech Republic
| | - Danielle R Lavage
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and UPMC, 200 Lothrop St, Pittsburgh PA 15213, United States
| | - Milan Dusik
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 499/2, 128 08 Prague, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 499/2, 128 08 Prague, Czech Republic
| | - Tomas Drabek
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine and UPMC, 200 Lothrop St, Pittsburgh PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, John G. Rangos Research Center, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
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Kawauchi A, Okada Y, Aoki M, Ogasawara T, Tagami T, Kitamura N, Nakamura M. Evaluating the impact of ELSO guideline adherence on favorable neurological outcomes among patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Resuscitation 2024; 199:110218. [PMID: 38649088 DOI: 10.1016/j.resuscitation.2024.110218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
AIM Selecting the appropriate candidates for extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is challenging. Previously, the Extracorporeal Life Support Organization (ELSO) guidelines suggested the example of inclusion criteria. However, it is unclear whether patients who meet the inclusion criteria of the ELSO guidelines have more favorable outcomes. We aimed to evaluate the relationship between the outcomes and select inclusion criteria of the ELSO guidelines. METHODS We conducted a post-hoc analysis of a multicenter prospective study conducted between 2019 and 2021. Adult patients with OHCA treated with ECPR were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. An ELSO criteria score was assigned based on four criteria: (i) age < 70 years; (ii) witness; (iii) bystander CPR; and (iv) low-flow time (<60 min). Subgroup analysis based on initial cardiac rhythm was performed. RESULTS Among 9,909 patients, 227 with OHCA were included. The proportion of favorable neurological outcomes according to the number of ELSO criteria met were: 0.0% (0/3), 0 points; 0.0% (0/23), 1 point; 3.0% (2/67), 2 points; 7.3% (6/82), 3 points; and 16.3% (7/43), 4 points. A similar tendency was observed in patients with an initial shockable rhythm. However, no such relationship was observed in those with an initial non-shockable rhythm. CONCLUSION Patients who adhered more closely to specific inclusion criteria of the ELSO guidelines demonstrated a tendency towards a higher rate of favorable neurological outcomes. However, the relationship was heterogeneous according to initial rhythm.
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Affiliation(s)
- Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan.
| | - Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Makoto Aoki
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Tomoko Ogasawara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba Japan
| | - Mitsunobu Nakamura
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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8
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Shinar Z, Dos Reis Miranda D. Heroism, futility, and lactate physiology. Resuscitation 2024; 198:110192. [PMID: 38522731 DOI: 10.1016/j.resuscitation.2024.110192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
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9
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Thevathasan T, Gregers E, Rasalingam Mørk S, Degbeon S, Linde L, Bønding Andreasen J, Smerup M, Eifer Møller J, Hassager C, Laugesen H, Dreger H, Brand A, Balzer F, Landmesser U, Juhl Terkelsen C, Flensted Lassen J, Skurk C, Søholm H. Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation - An international, multicentre cohort study. Resuscitation 2024; 198:110149. [PMID: 38403182 DOI: 10.1016/j.resuscitation.2024.110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. In this study, it was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients. METHODS Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes. RESULTS 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30-13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09-0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank < 0.001) and subgroup analyses. CONCLUSION Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anna Brand
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3rd Floor, 1120 Copenhagen, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
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10
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Grunau B, Bělohlávek J. Candidacy Assessment for Extracorporeal CPR in Out-of-Hospital Cardiac Arrest: Still Much to Learn. Chest 2024; 165:759-761. [PMID: 38599746 DOI: 10.1016/j.chest.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 04/12/2024] Open
Affiliation(s)
- Brian Grunau
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada; Departments of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Internal Medicine II, Cardiovascular Medicine, 1st Medical School, Charles University and General University Hospital, Prague, Czech Republic; Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland.
| | - Jan Bělohlávek
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada; Departments of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Internal Medicine II, Cardiovascular Medicine, 1st Medical School, Charles University and General University Hospital, Prague, Czech Republic; Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
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11
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Tigges E, Michels G, Preusch MR, Wengenmayer T, Staudacher DL. [Extracorporeal life support (ECLS)-update 2023]. Med Klin Intensivmed Notfmed 2024; 119:136-140. [PMID: 38206378 DOI: 10.1007/s00063-023-01103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Eike Tigges
- Kardiologie und Internistische Intensivmedizin, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Guido Michels
- Krankenhaus der Barmherzigen Brüder Trier, Medizincampus Trier der Universitätsmedizin Mainz, Notfallzentrum, Trier, Deutschland.
- Krankenhaus der Barmherzigen Brüder Trier, Medizincampus Trier der Universitätsmedizin Mainz, Notfallzentrum, Nordallee 1, 54292, Trier, Deutschland.
| | - Michael R Preusch
- Sektion Internistische Intensivmedizin, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Tobias Wengenmayer
- Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Dawid L Staudacher
- Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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12
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Hirsch KG, Tamura T, Ristagno G, Sekhon MS. Wolf Creek XVII Part 8: Neuroprotection. Resusc Plus 2024; 17:100556. [PMID: 38328750 PMCID: PMC10847936 DOI: 10.1016/j.resplu.2024.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Introduction Post-cardiac arrest brain injury (PCABI) is the primary determinant of clinical outcomes for patients who achieve return of spontaneous circulation after cardiac arrest (CA). There are limited neuroprotective therapies available to mitigate the acute pathophysiology of PCABI. Methods Neuroprotection was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of CA resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation, and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top 5 knowledge gaps included developing therapies for neuroprotection; improving understanding of the pathophysiology, mechanisms, and natural history of PCABI; deploying precision medicine approaches; optimizing resuscitation and CPR quality; and determining optimal timing for and duration of interventions. Top 5 barriers to translation included patient heterogeneity; nihilism & lack of knowledge about cardiac arrest; challenges with the translational pipeline; absence of mechanistic biomarkers; and inaccurate neuro-triage and neuroprognostication. Top 5 research priorities focused on translational research and trial optimization; addressing patient heterogeneity and individualized interventions; improving understanding of pathophysiology and mechanisms; developing mechanistic and outcome biomarkers across post-CA time course; and improving implementation of science and technology. Conclusion This overview can serve as a guide to transform the care and outcome of patients with PCABI. Addressing these topics has the potential to improve both research and clinical care in the field of neuroprotection for PCABI.
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Affiliation(s)
- Karen G. Hirsch
- Department of Neurology, Stanford University, Stanford, CA, United States
| | - Tomoyoshi Tamura
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mypinder S. Sekhon
- Division of Critical Care Medicine and Department of Medicine, University of British Columbia, Vancouver, Canada
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13
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Tonna JE. How confidently can we prognosticate survival when starting ECPR? Resuscitation 2023; 192:109972. [PMID: 37734701 PMCID: PMC10642582 DOI: 10.1016/j.resuscitation.2023.109972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA; Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA.
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