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Shin YS, Kang PJ, Kim YJ, Ryoo SM, Jung SH, Hong SB, Kim WY. The feasibility of extracorporeal cardiopulmonary resuscitation for patients with active cancer who undergo in-hospital cardiac arrest. Sci Rep 2022; 12:1653. [PMID: 35102240 PMCID: PMC8803995 DOI: 10.1038/s41598-022-05786-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
Indications of extracorporeal cardiopulmonary resuscitation (ECPR) are still debatable, particularly in patients with cancer. Prediction of the prognosis of in-hospital cardiac arrest (IHCA) in patients with cancer receiving ECPR is important given the increasing prevalence and survival rate of cancer. We compared the neurologic outcomes and survival rates of IHCA patients with and without cancer receiving ECPR. Data from the extracorporeal membrane oxygenation registry between 2015 and 2019 were used in a retrospective manner. The primary outcome was 6-month good neurologic outcome, defined as a Cerebral performance category score of 1 or 2. The secondary outcomes were 1- and 3-month good neurologic outcome, and 6-month survival. Among 247 IHCA patients with ECPR, 43 had active cancer. The 6-month good neurologic outcome rate was 27.9% and 32.4% in patients with and without active cancer, respectively (P > 0.05). Good neurologic outcomes at 1-month (30.2% vs. 20.6%) and 3-month (30.2% vs. 28.4%), and the survival rate at 6-month (39.5% vs. 36.5%) were not significantly different (all P > 0.05) Active cancer was not associated with 6-month good neurologic outcome by logistic regression analyses. Therefore, patients with IHCA should not be excluded from ECPR solely for the presence of cancer itself.
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Kim SJ, Han KS, Lee EJ, Lee SJ, Lee JS, Lee SW. Association between Extracorporeal Membrane Oxygenation (ECMO) and Mortality in the Patients with Cardiac Arrest: A Nation-Wide Population-Based Study with Propensity Score Matched Analysis. J Clin Med 2020; 9:jcm9113703. [PMID: 33218192 PMCID: PMC7699277 DOI: 10.3390/jcm9113703] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
We attempted to determine the impact of extracorporeal membrane oxygenation (ECMO) on short-term and long-term outcomes and find potential resource utilization differences between the ECMO and non-ECMO groups, using the National Health Insurance Service database. We selected adult patients (≥20 years old) with non-traumatic cardiac arrest from 2007 to 2015. Data on age, sex, insurance status, hospital volume, residential area urbanization, and pre-existing diseases were extracted from the database. A total of 1.5% (n = 3859) of 253,806 patients were categorized into the ECMO group. The ECMO-supported patients were more likely to be younger, men, more covered by national health insurance, and showed, higher usage of tertiary level and large volume hospitals, and a lower rate of pre-existing comorbidities, compared to the non-ECMO group. After propensity score-matching demographic data, hospital factors, and pre-existing diseases, the odds ratio (ORs) of the ECMO group were 0.76 (confidence interval, (CI) 0.68–0.85) for 30-day mortality and 0.66 (CI 0.58–0.79) for 1-year mortality using logistic regression. The index hospitalization was longer, and the 30-day and 1-year hospital costs were greater in the matched ECMO group. Although ECMO support needed longer hospitalization days and higher hospital costs, the ECMO support reduced the risk of 30-day and 1-year mortality compared to the non-ECMO patients.
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Affiliation(s)
- Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (E.J.L.); (S.J.L.)
| | - Kap Su Han
- Department of Emergency Medicine, College of Medicine, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (E.J.L.); (S.J.L.)
| | - Eui Jung Lee
- Department of Emergency Medicine, College of Medicine, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (E.J.L.); (S.J.L.)
| | - Si Jin Lee
- Department of Emergency Medicine, College of Medicine, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (E.J.L.); (S.J.L.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, 88 Olympic-ro 43-gil, songpa-gu, Seoul 05505, Korea;
| | - Sung Woo Lee
- Department of Emergency Medicine, College of Medicine, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (E.J.L.); (S.J.L.)
- Correspondence: ; Tel.: +82-2-920-5408
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Sanford Z, Madathil RJ, Deatrick KB, Tabatabai A, Menaker J, Galvagno SM, Mazzeffi MA, Rabin J, Ghoreishi M, Rector R, Herr DL, Kaczorowski DJ. Extracorporeal Membrane Oxygenation for COVID-19. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:306-313. [PMID: 32692258 DOI: 10.1177/1556984520937821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Zachary Sanford
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA
| | - Ronson J Madathil
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA
| | - Kristopher B Deatrick
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA
| | - Ali Tabatabai
- Program in Trauma, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Jay Menaker
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA.,Program in Trauma, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Samuel M Galvagno
- Program in Trauma, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Michael A Mazzeffi
- Program in Trauma, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Joseph Rabin
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA.,Program in Trauma, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mehrdad Ghoreishi
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA
| | - Raymond Rector
- 12265 Perioperative Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel L Herr
- Program in Trauma, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - David J Kaczorowski
- 2166812264 Department of Surgery, University of Maryland Medical School of Medicine, Baltimore, MD, USA
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Pasrija C, Bittle GJ, Zhang J, Morales D, Tran D, Deatrick KB, Gammie JS, Wu Z, Griffith BP, Kon ZN, Kaczorowski DJ. A novel adaptor system enables endovascular access through extracorporeal life support circuits. J Thorac Cardiovasc Surg 2019; 158:1359-1366. [DOI: 10.1016/j.jtcvs.2019.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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Lee SW, Han KS, Park JS, Lee JS, Kim SJ. Prognostic indicators of survival and survival prediction model following extracorporeal cardiopulmonary resuscitation in patients with sudden refractory cardiac arrest. Ann Intensive Care 2017; 7:87. [PMID: 28856660 PMCID: PMC5577351 DOI: 10.1186/s13613-017-0309-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background Extracorporeal cardiopulmonary resuscitation (ECPR) has been considered in selected candidates with potentially reversible causes during a limited period. Candidate selection and the identification of predictable conditions are important factors in determining outcomes during CPR in the emergency department (ED). The objective of this study was to determine the key indicators and develop a prediction model for survival to hospital discharge in patients with sudden cardiac arrest who received ECPR. Methods This retrospective analysis was based on a prospective cohort, which included data on CPR with ECPR-related variables. Patients with sudden cardiac arrest who received ECPR at the ED from May 2006 to June 2016 were included. The primary outcome was survival to discharge. Prognostic indicators and the prediction model were analyzed using logistic regression. Results Out of 111 ECPR patients, there were 18.9% survivors. Survivors showed younger age, shorter CPR duration (p < 0.05) and had tendencies of higher rate of initial shockable rhythm (p = 0.055) and higher rate of any ROSC event before ECPR (p = 0.066) than non-survivors. Eighty-one percent of survivors showed favorable neurologic outcome at discharge. In univariate analysis, the following factors were associated with survival: no preexisting comorbidities, initial serum hemoglobin level ≥14 g/dL, and mean arterial pressure ≥60 mmHg after ECPR. Based on multivariate logistic regression, predictors for survival in ECPR were as follows: age ≤56 years, no asystole as the initial arrest rhythm, CPR duration of ≤55 min, and any return of spontaneous circulation (ROSC) event before ECPR. The prediction scoring model for survival had a c-statistic of 0.875. Conclusions With careful consideration of differences in the inclusion criteria, the prognostic indicators and prediction scoring model for survival in our study may be helpful in the rapid decision-making process for ECPR implementation during CPR in the ED.
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Affiliation(s)
- Sung Woo Lee
- Department of Emergency Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Kap Su Han
- Department of Emergency Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jong Su Park
- Department of Emergency Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival? Eur J Heart Fail 2017; 19 Suppl 2:110-116. [DOI: 10.1002/ejhf.854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 12/30/2022] Open
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Richardson A(SC, Schmidt M, Bailey M, Pellegrino VA, Rycus PT, Pilcher DV. ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation 2017; 112:34-40. [DOI: 10.1016/j.resuscitation.2016.12.009] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/10/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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Singal RK, Singal D, Bednarczyk J, Lamarche Y, Singh G, Rao V, Kanji HD, Arora RC, Manji RA, Fan E, Nagpal AD. Current and Future Status of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest. Can J Cardiol 2016; 33:51-60. [PMID: 28024556 DOI: 10.1016/j.cjca.2016.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 01/06/2023] Open
Abstract
Numerous series, propensity-matched trials, and meta-analyses suggest that appropriate use of extracorporeal cardiopulmonary resuscitation (E-CPR) for in-hospital cardiac arrest (IHCA) can be lifesaving. Even with an antecedent cardiopulmonary resuscitation (CPR) duration in excess of 45 minutes, 30-day survival with favourable neurologic outcome using E-CPR is approximately 35%-45%. Survival may be related to age, duration of CPR, or etiology. Associated complications include sepsis, renal failure, limb and neurologic complications, hemorrhage, and thrombosis. However, methodological biases-including small sample size, selection bias, publication bias, and inability to control for confounders-in these series prevent definitive conclusions. As such, the 2015 American Heart Association Advanced Cardiac Life Support guidelines update recommended E-CPR as a Level of Evidence IIb recommendation in appropriate cases. The absence of high-quality evidence presents an opportunity for clinician/scientists to generate practice-defining data through collaborative investigation and prospective trials. A multidisciplinary dialogue is required to standardize the field and promote multicentre investigation of E-CPR with data sharing and the development of a foundation for high-quality trials. The objectives of this review are to (1) provide an overview of the strengths and limitations of currently available studies investigating the use of E-CPR in patients with IHCA and highlight knowledge gaps; (2) create a framework for the standardization of terminology, clinical practice, data collection, and investigation of E-CPR for patients with IHCA that will help ensure congruence in future work in this area; and (3) propose suggestions to guide future research by the cardiovascular community to advance this important field.
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Affiliation(s)
- Rohit K Singal
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deepa Singal
- Department of Community Health Sciences, Max Rady College of Medicine, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph Bednarczyk
- Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute and Department of Critical Care, Hôpital du Sacré Coeur de Montréal, Université de Montréal, Québec, Canada
| | - Gurmeet Singh
- Departments of Critical Care Medicine and Surgery, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hussein D Kanji
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rizwan A Manji
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - A Dave Nagpal
- London Health Sciences Centre/Western University, London Ontario, Canada
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When extracorporeal CPR fails-fatal ionized hypocalcemia during cardiac arrest. Am J Emerg Med 2016; 34:2251.e1-2251.e2. [PMID: 27113129 DOI: 10.1016/j.ajem.2016.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 11/21/2022] Open
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