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Kruse JM, Nee J, Eckardt KU, Wengenmayer T. [Open questions with respect to extracorporeal circulatory support 2024]. Med Klin Intensivmed Notfmed 2024; 119:346-351. [PMID: 38568446 DOI: 10.1007/s00063-024-01131-1] [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: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 05/28/2024]
Abstract
The use of extracorporeal circulatory support, both for cardiogenic shock and during resuscitation, still presents many unanswered questions. The inclusion and exclusion criteria for such a resource-intensive treatment must be clearly defined, considering that these criteria are directly associated with the type and location of treatment. For example, it is worth questioning the viability of an extracorporeal resuscitation program in areas where it is impossible to achieve low-flow times under 60 min due to local limitations. Additionally, the best approach for further treatment, including whether it is necessary to regularly relieve the left ventricle, must be explored. To find answers to some of these questions, large-scale, multicenter, randomized studies and registers must be performed. Until then this treatment must be carefully considered before use.
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Affiliation(s)
- J-M Kruse
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - J Nee
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - K-U Eckardt
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - T Wengenmayer
- Interdisziplinäre Medizinische Intensivtherapie (IMT), Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
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2
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Sucunza AE, Fernández del Valle P, Vázquez JAI, Azeli Y, Navalpotro Pascual JM, Rodriguez JV, Barreras CF, Embid SR, Gutiérrez-García C, Rozalén MIC, García CMG, del Pozo Pérez C, Luque-Hernández MJ, Muñoz SS, Canos ABF, Maíllo MIH, García MJ, García NR, Isabel BM, Mendoza JJG, Ramas JAC, Revilla FR, Mateo-Rodríguez I, Sanz FR, Knox E, Codina AD, Azpiazu JIR, Ortiz FR. Ongoing CPR with an onboard physician. Resusc Plus 2024; 18:100635. [PMID: 38646093 PMCID: PMC11026836 DOI: 10.1016/j.resplu.2024.100635] [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: 04/23/2024] Open
Abstract
Introduction Recent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status. Methods An observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described. Results A total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; p < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; p < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; p < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; p < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; p < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2). Conclusions The strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.
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Affiliation(s)
| | | | | | - Youcef Azeli
- Sistema de Emergencies Mediques, Catalunya. Institut d' Investigació Sanitaria Pere i Virgili, Tarragona (IISPV) , Spain
| | | | | | | | | | | | | | | | | | | | - Silvia Sola Muñoz
- Sistema de Emergencies Mediques, Catalunya. Institut d' Investigació Sanitaria Pere i Virgili, Tarragona (IISPV) , Spain
| | | | | | | | | | | | | | | | | | - Inmaculada Mateo-Rodríguez
- Andalusian School of Public Health, Universidad Nacional a Distancia (UNED). CIBER Epidemiology and Public Health (CIBERESP), Spain
| | | | - Emily Knox
- CIBER Epidemiology and Public Health (CIBERESP), Spain
| | - Antonio Daponte Codina
- Andalusian School of Public Health. CIBER Epidemiology and Public Health (CIBERESP), Spain
| | - José Ignacio Ruiz Azpiazu
- Servicio de Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Spain
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Spain
| | - On behalf of OHSCAR investigators group
- Servicio de Urgencias Extrahospitalarias de Navarra, Spain
- M Stat. Agencia de Servicios Sociales y Dependencia de Andalucía, Spain
- Fundación Pública Urxencias Sanitarias 061, Galicia, Spain
- Sistema de Emergencies Mediques, Catalunya. Institut d' Investigació Sanitaria Pere i Virgili, Tarragona (IISPV) , Spain
- SUMMA-112 Madrid, Spain
- Gerencia de Urgencias, Emergencias y Transporte Sanitario, Spain
- Emergentziak-Emergencias, Osakidetza, Euzkadi, Spain
- 061 e Instituto de Ciencias de la Salud, Aragón, Spain
- Centro de Emergencias 061, SP Málaga, Andalucía, Spain
- SAMU061-IB-SALUT, Spain
- 061 Cantabria, Spain
- Emergencias Sanitarias, Castilla y León, Spain
- SAMU, Emergencias Sanitarias, Comunidad Valenciana, Spain
- Emergencias Sanitarias extrahospitalarias de Extremadura. ESEX 112 Extremadura, Spain
- Servicio de Emergencias 061 de La Rioja, Spain
- SAMUR Protección Civil, Spain
- SUMMA 112, Spain
- Servicio de Bomberos de Zaragoza, Aragón, Spain
- Servicio de Urgencias Canario (SUC), Spain
- Andalusian School of Public Health, Universidad Nacional a Distancia (UNED). CIBER Epidemiology and Public Health (CIBERESP), Spain
- Fundación Rioja Salud. Unidad de la Ciencia del dato, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Spain
- Andalusian School of Public Health. CIBER Epidemiology and Public Health (CIBERESP), Spain
- Servicio de Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Spain
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Spain
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Lüsebrink E, Binzenhöfer L, Hering D, Villegas Sierra L, Schrage B, Scherer C, Speidl WS, Uribarri A, Sabate M, Noc M, Sandoval E, Erglis A, Pappalardo F, De Roeck F, Tavazzi G, Riera J, Roncon-Albuquerque R, Meder B, Luedike P, Rassaf T, Hausleiter J, Hagl C, Zimmer S, Westermann D, Combes A, Zeymer U, Massberg S, Schäfer A, Orban M, Thiele H. Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence? Circulation 2024; 149:1033-1052. [PMID: 38527130 DOI: 10.1161/circulationaha.123.067087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support in various clinical scenarios has been increasing consistently, despite the lack of sufficient evidence regarding its benefit and safety from adequately powered randomized controlled trials. Although the ARREST trial (Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation) and a secondary analysis of the PRAGUE OHCA trial (Prague Out-of-Hospital Cardiac Arrest) provided some evidence in favor of VA-ECMO in the setting of out-of-hospital cardiac arrest, the INCEPTION trial (Early Initiation of Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest) has not found a relevant improvement of short-term mortality with extracorporeal cardiopulmonary resuscitation. In addition, the results of the recently published ECLS-SHOCK trial (Extracorporeal Life Support in Cardiogenic Shock) and ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) discourage the routine use of VA-ECMO in patients with infarct-related cardiogenic shock. Ongoing clinical trials (ANCHOR [Assessment of ECMO in Acute Myocardial Infarction Cardiogenic Shock, NCT04184635], REVERSE [Impella CP With VA ECMO for Cardiogenic Shock, NCT03431467], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO, NCT05577195], PIONEER [Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI, NCT04045873]) may clarify the usefulness of VA-ECMO in specific patient subpopulations and the efficacy of combined mechanical circulatory support strategies. Pending further data to refine patient selection and management recommendations for VA-ECMO, it remains uncertain whether the present usage of this device improves outcomes.
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Affiliation(s)
- Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Leonhard Binzenhöfer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Daniel Hering
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Laura Villegas Sierra
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany and DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany (B.S.)
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (W.S.S.)
| | - Aitor Uribarri
- Cardiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER-CV (A.U.)
| | - Manel Sabate
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (M.S.)
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia (M.N.)
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain (E.S.)
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia (A.E.)
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (F.P.)
| | - Frederic De Roeck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium (F.D.R.)
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia Intensive Care, Fondazione IRCCS Policlinico San Matteo, Italy (G.T.)
| | - Jordi Riera
- Intensive Care Department, Vall d'Hebron University Hospital, and SODIR, Vall d'Hebron Research Institute, Barcelona, Spain (J.R.)
| | - Roberto Roncon-Albuquerque
- Department of Intensive Care Medicine, São João University Hospital Center, UnIC@RISE and Department of Surgery and Physiology, Faculty of Medicine of Porto, Portugal (R.R.-A.)
| | - Benjamin Meder
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Germany (B.M.)
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (P.L., T.R.)
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (P.L., T.R.)
| | - Jörg Hausleiter
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (C.H.)
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, Germany (S.Z.)
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Germany (D.W.)
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France, and Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France (A.C.)
| | - Uwe Zeymer
- Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany (U.Z.)
| | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Science, Germany (H.T.)
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Puolakka T, Salo A, Varpula M, Nurmi J, Skrifvars MB, Wilkman E, Lemström K, Kuisma M. Hospital-administered ECPR for out-of-hospital cardiac arrest: an observational cohort study. Emerg Med J 2023; 40:754-760. [PMID: 37699713 DOI: 10.1136/emermed-2023-213292] [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: 04/17/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment method for refractory out-of-hospital cardiac arrest (OHCA) requiring a complex chain of care. METHODS All cases of OHCA between 1 January 2016 and 31 December 2021 in the Helsinki University Hospital catchment area in which the ECPR protocol was activated were included in the study. The protocol involved patient transport from the emergency site with ongoing mechanical cardiopulmonary resuscitation (CPR) directly to the cardiac catheterisation laboratory where the implementation of extracorporeal membrane oxygenation (ECMO) was considered. Cases of hypothermic cardiac arrest were excluded. The main outcomes were the number of ECPR protocol activations, duration of prehospital and in-hospital time intervals, and whether the ECPR candidates were treated using ECMO or not. RESULTS The prehospital ECPR protocol was activated in 73 cases of normothermic OHCA. The mean patient age (SD) was 54 (±11) years and 67 (91.8%) of them were male. The arrest was witnessed in 67 (91.8%) and initial rhythm was shockable in 61 (83.6%) cases. The median ambulance response time (IQR) was 9 (7-11) min. All patients received mechanical CPR, epinephrine and/or amiodarone. Seventy (95.9%) patients were endotracheally intubated. The median (IQR) highest prehospital end-tidal CO2 was 5.5 (4.0-6.9) kPa.A total of 37 (50.7%) patients were treated with venoarterial ECMO within a median (IQR) of 84 (71-105) min after the arrest. Thirteen (35.1%) of them survived to discharge and 11 (29.7%) with a cerebral performance category (CPC) 1-2. In those ECPR candidates who did not receive ECMO, 8 (22.2%) received permanent return of spontaneuous circulation during transport or immediately after hospital arrival and 6 (16.7%) survived to discharge with a CPC 1-2. CONCLUSIONS Half of the ECPR protocol activations did not lead to ECMO treatment. However, every fourth ECPR candidate and every third patient who received ECMO-facilitated resuscitation at the hospital survived with a good neurological outcome.
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Affiliation(s)
- Tuukka Puolakka
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Ari Salo
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Marjut Varpula
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - Jouni Nurmi
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Erika Wilkman
- Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Karl Lemström
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Markku Kuisma
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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5
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Mistraletti G, Lancioni A, Bassi G, Nespoli F, Umbrello M, Salini S, Zangrillo A, Pappalardo F, Scandroglio AM, Foti G, Avalli L, Patroniti N, Raimondi F, Costantini E, Catena E, Ottolina D, Ruffini C, Migliari M, Sesana G, Fumagalli R, Pesenti A. Mechanical chest compression and extracorporeal life support for out-of-hospital cardiac arrest. A 30-month observational study in the metropolitan area of Milan, Italy. Resuscitation 2023; 182:109659. [PMID: 36503025 DOI: 10.1016/j.resuscitation.2022.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Return of spontaneous circulation (ROSC) is achieved in 25% of out-of-hospital cardiac arrest (OHCA) patients. Mechanical chest compression (mechCPR) may maintain better perfusion during transport, allowing hospital treatments like extracorporeal circulation life support (ECLS). We aim to assess the effectiveness of a pre-hospital protocol introduction. METHODS Observational, retrospective study assessing all OHCA patients aged 12-75, with no-flow time <20 min in a metropolitan area (Milan, Italy, 2013-2016). PRIMARY OUTCOMES ROSC and Cerebral Performance Category score (CPC) ≤2 at hospital discharge. Logistic regressions with multiple comparison adjustments balanced with propensity scores calculated with inverse probability of treatment weighting were performed. RESULTS 1366 OHCA were analysed; 305 received mechCPR, 1061 manual chest compressions (manCPR), and 108 ECLS. ROSC and CPC ≤2 were associated with low-flow minutes (odds ratio [95% confidence interval] 0.90 [0.88-0.91] and 0.90 [0.87-0.93]), shockable rhythm (2.52 [1.71-3.72] and 10.68 [5.63-20.28]), defibrillations number (1.15 [1.07-1.23] and 1.15 [1.04-1.26]), and mechCPR (1.86 [1.17-2.96] and 2.06 [1.11-3.81]). With resuscitation times >13 min, mechCPR achieved more frequently ROSC compared to manCPR. Among ECLS patients, 70% had time exceeding protocol: 8 (7.5%) had CPC ≤2 (half of them with low-flow times between 45 and 90 min), 2 (1.9%) survived with severe neurological disabilities, and 13 brain-dead (12.0%) became organ donors. CONCLUSIONS MechCPR patients achieved ROSC more frequently than manual CPR patients; mechCPR was a crucial factor in an ECLS protocol for refractory OHCA. ECLS offered a chance of survival to patients who would otherwise die.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; UOC Anestesia e Rianimazione, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Milano, Italy.
| | - Armando Lancioni
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy; Servizio di Anestesia e Rianimazione 1, Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Gabriele Bassi
- Servizio di Anestesia e Rianimazione 1, Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Francesca Nespoli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy; Servizio di Anestesia e Rianimazione 1, Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Michele Umbrello
- S.C. Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST dei Santi Paolo e Carlo, Milano, Italy.
| | - Silvia Salini
- Dipartimento di Economia, Management e Metodi Quantitativi, Data Science Research Center, Università degli Studi di Milano, Italy.
| | - Alberto Zangrillo
- Dipartimento Cardio-Toraco-Vascolare, IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Federico Pappalardo
- Dipartimento di Anestesia e Rianimazione Cardio-Toraco-Vascolare, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | | | - Giuseppe Foti
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy; UOC Anestesia e Rianimazione, Ospedale San Gerardo, ASST Monza, Italy.
| | - Leonello Avalli
- UOC Anestesia e Rianimazione, Ospedale San Gerardo, ASST Monza, Italy.
| | - Nicolò Patroniti
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Italy.
| | - Ferdinando Raimondi
- Dipartimento di Anestesia e Rianimazione, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy.
| | - Elena Costantini
- Dipartimento di Anestesia e Rianimazione, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy.
| | - Emanuele Catena
- UOC Anestesia e Rianimazione, Ospedale Luigi Sacco, Milano, Italy.
| | - Davide Ottolina
- UOC Anestesia e Rianimazione, Ospedale Luigi Sacco, Milano, Italy.
| | - Claudia Ruffini
- UOC Anestesia e Rianimazione, Ospedale Luigi Sacco, Milano, Italy.
| | | | - Giovanni Sesana
- SOREUM Sala Operativa Emergenza Urgenza Metropolitana, AREU, Milano, Italy.
| | - Roberto Fumagalli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy; Servizio di Anestesia e Rianimazione 1, Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milano, Italy; SOREUM Sala Operativa Emergenza Urgenza Metropolitana, AREU, Milano, Italy.
| | - Antonio Pesenti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
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6
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Cassara CM, Long MT, Dollerschell JT, Chae F, Hall DJ, Demiralp G, Stampfl MJ, Bernardoni B, McCarthy DP, Glazer JM. Extracorporeal Cardiopulmonary Resuscitation: A Narrative Review and Establishment of a Sustainable Program. Medicina (B Aires) 2022; 58:medicina58121815. [PMID: 36557017 PMCID: PMC9781756 DOI: 10.3390/medicina58121815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
The rates of survival with functional recovery for out of hospital cardiac arrest remain unacceptably low. Extracorporeal cardiopulmonary resuscitation (ECPR) quickly resolves the low-flow state of conventional cardiopulmonary resuscitation (CCPR) providing valuable perfusion to end organs. Observational studies have shown an association with the use of ECPR and improved survivability. Two recent randomized controlled studies have demonstrated improved survival with functional neurologic recovery when compared to CCPR. Substantial resources and coordination amongst different specialties and departments are crucial for the successful implementation of ECPR. Standardized protocols, simulation based training, and constant communication are invaluable to the sustainability of a program. Currently there is no standardized protocol for the post-cannulation management of these ECPR patients and, ideally, upcoming studies should aim to evaluate these protocols.
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Affiliation(s)
- Chris M. Cassara
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
- Correspondence: ; Tel.: +1-608-263-8100
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - John T. Dollerschell
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Floria Chae
- Department of Anesthesiology, Ohio State University Wexner Medical Center, 370 W. 9th Ave., Columbus, OH 43210, USA
| | - David J. Hall
- Department of Surgery, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Gozde Demiralp
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Matthew J. Stampfl
- Department of Emergency Medicine, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Brittney Bernardoni
- Department of Emergency Medicine, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Daniel P. McCarthy
- Department of Surgery, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Joshua M. Glazer
- Department of Emergency Medicine, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
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Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2022; 30:5. [PMID: 35033185 PMCID: PMC8760684 DOI: 10.1186/s13049-022-00993-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-00993-8.
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Beyersdorf F, Trummer G, Benk C, Pooth JS. Application of cardiac surgery techniques to improve the results of cardiopulmonary resuscitation after cardiac arrest: Controlled automated reperfusion of the whole body. JTCVS OPEN 2021; 8:47-52. [PMID: 36004144 PMCID: PMC9390159 DOI: 10.1016/j.xjon.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/13/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Friedhelm Beyersdorf
- Address for reprints: Friedhelm Beyersdorf, MD, Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetterstr 55, D-79106 Freiburg, Germany.
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How effective is extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest? A systematic review and meta-analysis. Am J Emerg Med 2021; 51:127-138. [PMID: 34735971 DOI: 10.1016/j.ajem.2021.08.072] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) has gained increasing as a promising but resource-intensive intervention for out-of-hospital cardiac arrest (OHCA). There is little data to quantify the impact of this intervention and the patients likely to benefit from its use. We conducted a meta-analysis of the literature to assess the survival benefit associated with ECPR for OHCA. METHODS We searched PubMed, Embase, and Scopus databases to identify relevant observational studies and randomized control trials. We used the Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to assess studies' quality. We performed random-effects meta-analysis for the primary outcome of survival to hospital discharge and used meta-regressions to assess heterogeneity. RESULTS We identified 1287 articles, reviewed the full text of 209 and included 44 in our meta-analysis. Our analysis included 3097 patients with OHCA. Patients' mean age was 52, 79% were male, and 60% had primary ventricular fibrillation/ventricular tachycardia arrest. We identified a survival-to-discharge rate of 24%; 18% survived with favorable neurologic function. 30- and 90-days survival rates were both around 18%. The majority of included articles were high quality studies. CONCLUSIONS Extracorporeal cardiopulmonary resuscitation is a promising but resource-intensive intervention that may increase rates of survival to hospital discharge among patients who experience OHCA.
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