The physiologic response to rescue therapy with vasopressin versus epinephrine during experimental pediatric cardiac arrest

Abstract Background: While epinephrine is the mainstay of therapy during cardiopulmonary resuscitation, it is potentially detrimental to the cerebral vasculature and ineffective in certain populations. This study compares a rescue dose of vasopressin to a rescue dose of epinephrine after ineffective initial doses of epinephrine in diverse models of pediatric in-hospital cardiac arrest. 67 one- to three-month old female swine (10-30kg) in six experimental cohorts from one laboratory received hemodynamic-directed CPR, a resuscitation method where high quality chest compressions are provided and vasopressor administration is titrated to coronary perfusion pressure (CoPP) ³20 mmHg. Vasopressors are given when CoPP is <20 mmHg, in sequences of two doses of 0.02 mg/kg epinephrine separated by minimum one-minute, then a rescue dose of 0.4 U/kg vasopressin followed by minimum two-minutes. Invasive measurements were used to evaluate and compare the hemodynamic and neurologic effects of each vasopressor dose. Results: Increases in CoPP and cerebral blood flow (CBF) were greater with vasopressin rescue than epinephrine rescue (CoPP: +8.16 [4.35, 12.06] mmHg vs. +5.43 [1.56, 9.82] mmHg, p=0.022; CBF: +14.58 [-0.05, 38.12] vs. +0.00 [-0.77, 18.24] perfusion units (PFU), p=0.005). Twenty animals (30%) failed to achieve CoPP ³20 mmHg after two doses of epinephrine; 9/20 (45%) non-responders achieved CoPP ³20 mmHg after vasopressin. Among all animals, the increase in CBF was greater with vasopressin (+14.58 [-0.58, 38.12] vs. 0.00 [-0.77, 18.24] PFU, p=0.005).Conclusions: CoPP and CBF rose significantly more after rescue vasopressin than after rescue epinephrine. Importantly, CBF increased after vasopressin rescue, but not after epinephrine rescue. In the 30% that failed to meet CoPP of 20mmHg after two doses of epinephrine, 45% achieved target CoPP with a single rescue vasopressin dose.

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Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

10.21203/rs.3.rs-1083706/v1 ◽

2021 ◽

Author(s):

Pramod Chandru ◽

Tatum Priyambada Mitra ◽

Nitesh Dutt Dhanekula ◽

Mark Dennis ◽

Adam Eslick ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Rescue Therapy ◽

A Priori ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Eligibility Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Poor Outcomes ◽

Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

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Abstract 165: Impact of Prehospital Epinephrine for Patients Treated With Extracorporeal Cardiopulmonary Resuscitation After Refractory Out-Of-Hospital Shockable Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.165 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Ken Nagao ◽

Yoshio Tahara ◽

Hiroshi Nonogi ◽

Naohiro Yonemoto ◽

David Gaieski ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Standard Dose ◽

Rescue Therapy ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Arrival ◽

Curve Estimation ◽

Favorable Neurological Outcome ◽

Neurologically Intact

Background: The 2015 CoSTR recommended that standard-dose epinephrine (SDE) was reasonable for patients with out-of-hospital cardiac arrest (OHCA) and extracorporeal cardiopulmonary resuscitation (ECPR) was reasonable rescue therapy for selected patients with ongoing cardiac arrest when initial conventional CPR was unsuccessful. We investigated the effect of prehospital SDE for patients who met the criteria of ECPR. Methods: From the All-Japan OHCA Utstein Registry between 2007 and 2015, we included 22,552 patients who met the criteria of ECPR of the SAVE-J study (age between 20 and 75, witnessed shockable OHCA, cardiac arrest on hospital arrival, cardiac etiology, and collapse-to-ECPR interval within 60 minutes). Study patients were divided into two groups according to prehospital SDE or not. Primary endpoint was favorable 30-day neurological outcome after OHCA. Results: Of the 22,552 study patients, 5,659 (25%) received prehospital SDE and 16,893 (75%) did not. The SDE group resulted in lower proportion of favorable 30-day neurological outcome than the no-SDE group (5.6% versus 8.4%, p<0.001) with longer collapse-to-hospital-arrival interval (36.7±9.8 min vs. 29.6±11.3 min, p<0.001). After adjustment for independent predictors of resuscitation, prehospital SDE did not impact on neurological benifit (adjusted OR,1.13; 95%CI,0.98-1.29), but the collapse-to-hospital-arrival interval was associated with neurological benefit (adjusted OR, 0.94; 95% CI, 0.93-0.95). In curve estimation of the SDE group, when collapse-to-hospital-arrival interval was delayed, proportion of the favorable neurological outcome decreased to about 25% at 1 minute and about 0% at 54 minutes (R=0.14). In the 274 patients undergoing ECPR of the SAVE-J study, however, it was about 43% at 1 minute and about 0% at 96 minutes (R=0.17). Conclusions: Prehospital SDE did not improve likelihood of favorable neurological outcome for patients who met the criteria of ECPR (age between 20 and 75, witnessed shockable OHCA, cardiac arrest on hospital arrival, cardiac etiology and collapse-to-ECPR interval within 60 minutes), because SED administration delayed the collapse-to-hospital-arrival interval which was closely related to the neurologically intact survival on ECPR.

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Extracorporeal life support programme for out-of-hospital cardiac arrest during competitive sport events: the experience of the Volleyball Men’s World Championship Final Six in Turin (Italy)

Emergency Medicine Journal ◽

10.1136/emermed-2019-209203 ◽

2021 ◽

pp. emermed-2019-209203

Author(s):

Giancarlo Fornaro ◽

Federico Giovanni Canavosio ◽

Maria Luisa Contristano ◽

Daniela Pasero ◽

Gennaro Izzo ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Extracorporeal Life Support ◽

Rescue Therapy ◽

Standard Of Care ◽

Circulatory Support ◽

Operational Experience ◽

Sporting Events ◽

World Championship ◽

Hospital Cardiac Arrest

The high incidence of out-of-hospital cardiac arrest refractory to standard resuscitation protocols, despite precompetitive screening, demonstrated the need for a prehospital team to provide an effective system for life support and resuscitation at the Volleyball Men’s World Championship. The evolution of mechanical circulatory support suggests that current advanced cardiovascular life support protocols no longer represent the highest standard of care at competitive sporting events with large spectator numbers. Extracorporeal life support (ECLS) improves resuscitation strategies and offers a rescue therapy for refractory cardiac arrest that can no longer be ignored. We present our operational experience of an out-of-hospital ECLS cardiopulmonary resuscitation team at an international sporting event.

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Utilization of an Abiomed Impella Device as a Rescue Therapy for Acute Ventricular Failure in a Fontan Patient

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119847147 ◽

2019 ◽

Vol 10 (4) ◽

pp. 518-519

Author(s):

Zachary J. Coffman ◽

Varsha M. Bandisode ◽

Minoo N. Kavarana ◽

Jason R. Buckley

Keyword(s):

Cardiac Arrest ◽

Ventricular Assist Device ◽

Ventricular Dysfunction ◽

Rescue Therapy ◽

Mechanical Support ◽

Ventricular Failure ◽

Assist Device ◽

Fontan Patient ◽

Ventricular Assist ◽

Acute Setting

Progressive ventricular dysfunction is not uncommon in patients with univentricular hearts as they age. In the acute setting vasoactive support can be employed, but is not always sufficient and patients occasionally require mechanical support. We report the successful implantation and subsequent challenges of a percutaneous Abiomed Impella ventricular assist device as a rescue therapy for a 15-year old-patient with Fontan circulation and severe ventricular dysfunction after cardiac arrest.

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Correction to: A case of intracoronary and endovenous levosimendan as a rescue therapy for refractory cardiac arrest

Intensive Care Medicine Experimental ◽

10.1186/s40635-019-0289-3 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

B. Ferro ◽

R. Tofani ◽

L. Vegnuti ◽

G. Borelli ◽

L. Gargani ◽

...

Keyword(s):

Cardiac Arrest ◽

Rescue Therapy ◽

Refractory Cardiac Arrest

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Successful Outcome Following Intravenous Lipid Emulsion Rescue Therapy in a Patient with Cardiac Arrest Due to Amitriptyline Overdose

American Journal of Case Reports ◽

10.12659/ajcr.922206 ◽

2020 ◽

Vol 21 ◽

Cited By ~ 1

Author(s):

Ana María Angel Isaza ◽

Luis Alfonso Bustamante-Cristancho ◽

Francisco L. Uribe-B

Keyword(s):

Cardiac Arrest ◽

Lipid Emulsion ◽

Rescue Therapy ◽

Successful Outcome ◽

Intravenous Lipid Emulsion ◽

Amitriptyline Overdose

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Survival After Cardiac Arrest: ECMO Rescue Therapy After Amlodipine and Metoprolol Overdose

Cardiovascular Toxicology ◽

10.1007/s12012-016-9362-2 ◽

2016 ◽

Vol 17 (2) ◽

pp. 223-225 ◽

Cited By ~ 14

Author(s):

Kevin F. Maskell ◽

Nikki Miller Ferguson ◽

Jesse Bain ◽

Brandon K. Wills

Keyword(s):

Cardiac Arrest ◽

Rescue Therapy

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Short-term and intermediate outcomes of cardiogenic shock and cardiac arrest patients supported by venoarterial extracorporeal membrane oxygenation

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01674-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Deep Vakil ◽

Cassandra Soto ◽

Zoee D’Costa ◽

Lindsay Volk ◽

Sivaveera Kandasamy ◽

...

Keyword(s):

Cardiac Arrest ◽

Length Of Stay ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Rescue Therapy ◽

Demographic Data ◽

Primary Therapy ◽

Membrane Oxygenation ◽

Intermediate Outcomes ◽

Va Ecmo

Abstract Background Cardiogenic shock and cardiac arrest are life-threatening emergencies with high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) and extracorporeal cardiopulmonary resuscitation (e-CPR) provide viable options for life sustaining measures when medical therapy fails. The purpose of this study is to determine the utilization and outcomes of VA ECMO and eCPR in patients that require emergent cardiac support at a single academic center. Methods A retrospective chart review of prospectively collected data was performed at an academic institution from January 1st, 2018 to June 30th, 2020. All consecutive patients who required VA ECMO were evaluated based on whether they underwent traditional VA ECMO or eCPR. The study variables include demographic data, duration on ECMO, length of stay, complications, and survival to discharge. Results A total of 90 patients were placed on VA ECMO for cardiac support with 44.4% (40) of these patients undergoing eCPR secondary to cardiac arrest and emergent placement on ECMO. A majority of the patients were male (n = 64, 71.1%) and the mean age was 58.8 ± 15.8 years. 44.4% of patients were transferred from outside hospitals for a higher level of care and 37.8% of patients required another primary therapy such as an Impella or IABP. The most common complication experienced by patients was bleeding (n = 41, 45.6%), which occurred less often in eCPR (n = 29, 58% vs. n = 12, 30%). Other complications included infections (n = 11, 12.2%), limb ischemia (n = 13, 14.4%), acute kidney injury (n = 17, 18.9%), and cerebral vascular accident (n = 4, 4.4%). The length of stay was longer for patients on VA ECMO (32.1 ± 40.7 days vs. 17.7 ± 18.2 days). Mean time on ECMO was 8.1 ± 8.3 days. Survival to discharge was higher in VA ECMO patients (n = 23, 46% vs. n = 8, 20%). Conclusion VA ECMO provided an effective rescue therapy in patients in acute cardiogenic shock with a survival greater than the expected ELSO guidelines of 40%. While the survival of eCPR was lower than expected, this may reflect the severity of patient’s condition and emphasizes the importance of careful patient selection and planning.

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Using an Impella device to reverse refractory cardiac arrest and enable efficient coronary revascularisation

BMJ Case Reports ◽

10.1136/bcr-2019-230654 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230654

Author(s):

Nicolas Persico ◽

Christophe Guervilly ◽

Baptiste Verhamme ◽

Laurent Bonello

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Rescue Therapy ◽

Left Ventricular ◽

Low Flow ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Membrane Oxygenation ◽

Resuscitation Guidelines ◽

Refractory Cardiac Arrest

We report the case of a 54-year-old man who suffered from refractory cardiac arrest secondary to acute myocardial infarction. As veno-arterial extracorporeal membrane oxygenation was unavailable, mechanical chest compression was performed and an Impella device was used that immediately delivered at 3.2 l/min flow to reach the optimal mean arterial pressure. Within 1 min, return of spontaneous circulation was achieved and a 40% left ventricular ejection fraction was measured on echography. Then, the right coronary artery could be revascularised. Despite 62 min low flow, the patient was discharged home on day 19 without neurological sequelae. During refractory cardiac arrest, the European Resuscitation Guidelines indicate that veno-arterial extracorporeal membrane oxygenation should be considered as rescue therapy. Other mechanical circulatory supports such as an Impella device (left ventricular assist device propelling blood in the ascending aorta) can be a promising treatment in select patients; however, insufficient data in humans are available.

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