TCT-128 A systematic review and meta-analysis of extracorporeal life support during cardiac arrest and cardiogenic shock

Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO).Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P < 0.05 considered significant.Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis.Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.

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Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review

Perfusion ◽

10.1177/0267659120908413 ◽

2020 ◽

Vol 35 (1_suppl) ◽

pp. 20-28 ◽

Cited By ~ 3

Author(s):

Matteo Matteucci ◽

Mariusz Kowalewski ◽

Dario Fina ◽

Federica Jiritano ◽

Paolo Meani ◽

...

Keyword(s):

Systematic Review ◽

Cardiogenic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

Meta Analysis ◽

Specific Treatment ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Circulatory Support ◽

Ventricular Ejection Fraction

Introduction: Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock. Extracorporeal life support, in veno-arterial mode, application in refractory acute heart dysfunction is sharply increasing worldwide. However, its clinical utility in phaeochromocytoma-induced cardiogenic shock remains still unclear. Methods: A systematic review of published reports was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Searches were accomplished on PubMed, Embase and Google Scholar to identify articles describing the use of extracorporeal life support in the setting of phaeochromocytoma-induced cardiogenic shock (PROSPERO: CRD42019125225). Results: Thirty-five reports, including 62 patients supported with extracorporeal life support because of intractable phaeochromocytoma crisis, were included for the analysis. Almost all the subjects underwent peripheral cannulation for extracorporeal life support. The median duration of the mechanical circulatory support was 5 days, and most of the patients recovered normal myocardial function (left ventricular ejection fraction ⩾50%). In-hospital survival was 87%. Phaeochromocytoma was removed surgically during extracorporeal life support in 10 patients (16%), while in the remaining after haemodynamic stabilization and weaning from the mechanical support. Conclusion: Successful management of phaeochromocytoma-induced cardiogenic shock depends on prompt recognition and immediate treatment of shock. In this scenario, extracorporeal life support may play a significant role allowing cardiac and end-organ recovery and giving time for accurate diagnosis and specific treatment.

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Baseline surgical status and short-term mortality after extracorporeal membrane oxygenation for post-cardiotomy shock: a meta-analysis

Perfusion ◽

10.1177/0267659119865122 ◽

2019 ◽

Vol 35 (3) ◽

pp. 246-254

Author(s):

Mariusz Kowalewski ◽

Giuseppe Raffa ◽

Kamil Zieliński ◽

Paolo Meani ◽

Musab Alanazi ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

Meta Analysis ◽

Positive Association ◽

Neurological Complications ◽

Significant Positive Association ◽

Membrane Oxygenation ◽

Baseline Status

Objective: While reported mortality rates on post-cardiotomy extracorporeal membrane oxygenation vary from center to center, impact of baseline surgical status (elective/urgent/emergency/salvage) on mortality is still unknown. Methods: A systematic search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement using PubMed/Medline databases until March 2018 using the keywords “postcardiotomy,” “cardiogenic shock,” “extracorporeal membrane oxygenation,” and “extracorporeal life support.” Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and baseline surgical status. The correlations between mortality and percentage of elective/urgent/emergency cases were investigated. Inference analysis of baseline status and extracorporeal membrane oxygenation complications was conducted as well. Results: Twenty-two studies (conducted between 1993 and 2017) enrolling N = 2,235 post-cardiotomy extracorporeal membrane oxygenation patients were found. Patients were mostly of non-emergency status (65.2%). Overall in-hospital/30-day mortality event rate (95% confidence intervals) was 66.7% (63.3-69.9%). There were no differences in in-hospital/30-day mortality with respect to baseline surgical status in the subgroup analysis (test for subgroup differences; p = 0.406). Similarly, no differences between mortality in studies enrolling <50 versus ⩾50% of emergency/salvage cases was found: respective event rates were 66.9% (63.1-70.4%) versus 64.4% (57.3-70.8%); p = 0.525. Yet, there was a significant positive association between increasing percentage of emergency/salvage cases and rates of neurological complications (p < 0.001), limb complications (p < 0.001), and bleeding (p = 0.051). Incidence of brain death (p = 0.099) and sepsis (p = 0.134) was increased as well. Conclusion: Other factors than baseline surgical status may, to a higher degree, influence the mortality in patients treated with extracorporeal membrane oxygenation for post-cardiotomy cardiogenic shock. Baseline status, however, strongly influences the complication occurrence while on extracorporeal membrane oxygenation.

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High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

Journal of Thoracic Disease ◽

10.21037/jtd.2017.06.81 ◽

2017 ◽

Vol 9 (7) ◽

pp. 1988-1996 ◽

Cited By ~ 9

Author(s):

Matteo Pozzi ◽

Catherine Koffel ◽

Camelia Djaref ◽

Daniel Grinberg ◽

Jean Luc Fellahi ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiogenic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

High Rate ◽

Drug Intoxication ◽

Refractory Cardiogenic Shock ◽

Arterial Complications

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Outcomes of Coronary Artery Bypass Grafting after Extracorporeal Life Support in Patients with Cardiac Arrest or Cardiogenic Shock

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2019.52.2.70 ◽

2019 ◽

Vol 52 (2) ◽

pp. 70-77 ◽

Cited By ~ 1

Author(s):

Younghwan Kim ◽

Yang-Hyun Cho ◽

Ji-Hyuk Yang ◽

Kiick Sung ◽

Young Tak Lee ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Cardiogenic Shock ◽

Coronary Artery Bypass ◽

Life Support ◽

Extracorporeal Life Support ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting

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Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10163583 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3583

Author(s):

Styliani Syntila ◽

Georgios Chatzis ◽

Birgit Markus ◽

Holger Ahrens ◽

Christian Waechter ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiogenic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

Survival Rates ◽

Limb Ischemia ◽

Spontaneous Circulation ◽

Access Site ◽

Baseline Characteristics ◽

Hospital Cardiac Arrest

Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.

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