Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest

Abstract Background/Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to improve survival and neurologic outcome as compared to conventional CPR in refractory cardiac arrest. Although prognostic factors of these patients have been reported, predicting of outcome is difficult in real world. Recently, early evaluation of myocardial viability in acute myocardial infarction by non-contrast computed tomography (CT) post coronary angiography (CAG) has been reported. And myocardial contrast delayed enhancement obtained by this method related to higher risk of cardiac events. However, few studies have reported delayed enhancement on left ventricular wall findings in non-contrast CT after CAG in terms of patients performed ECPR. Purpose To investigate the impact of delayed hyperenhancement obtained by non-contrast CT following CAG in patients performed ECPR. Methods We investigated 79 patients treated by ECPR for refractory cardiac arrest regardless of whether in-hospital or out-hospital in our institute from Apr 2009 to Feb 2018. Thirty-two in these patients received non-contrast CT following CAG with ECPR were enrolled. All ECPR cases underwent VA-ECMO in the catheter laboratory using percutaneous procedure while maintaining conventional CPR. Non-ECG-gated and non-contrast CT was performed using a 64-row multidetector CT scanner. Results Survival rate was 18.8% in this cohort. There was no significant difference between survive and in-hospital death group in terms of patient characteristics, clinical time courses, initial blood samples and procedure characteristics. Only delayed hyperenhancement showed significant difference between 2 groups (p=0.04). All delayed hyperenhancements were detected in only in-hospital death group. Delayed hyperenhancement was detected in 12 cases (37.5%). Initial shockable rhythm was less common in cases with delayed hyperenhancement. Cardiac death tended to be more frequent in patients with delayed hyperenhancement. The major causes of death were bleeding (41.7%) and heart failure (33%). Conclusion(s) Delayed hyperenhancement in patients treated ECPR was strong predictor of in-hospital death. Image of delayed hyperenhancement Funding Acknowledgement Type of funding source: None

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Abstract 17412: Current Experience and Limitations of Extracorporeal Cardiopulmonary Resuscitation for Cardiac Arrest: A Single-Center Retrospective Study

Circulation ◽

10.1161/circ.138.suppl_1.17412 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Aditi Singhvi ◽

Nirav Patel ◽

Jason A Gluck

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Selection Criteria ◽

Spontaneous Circulation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurologic Outcomes ◽

Time To Initiation ◽

Central Access ◽

Refractory Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered for select cardiac arrest patients for whom the suspected etiology of the arrest is potentially reversible. In adults, the survival to discharge with ECPR is reportedly 22% to 33%, with better outcomes for in-hospital arrests. Outcomes with ECPR depend on multiple factors including, location of arrest, etiology, duration and quality of CPR, time to initiation of ECMO, and post-arrest management. There is no consensus regarding patient selection or management of these patients. We report our preliminary experiences with ECPR for refractory cardiac arrest. Methods: Patients who underwent ECPR between January 2013 and May 2018 were identified. The characteristics of the arrest, CPR duration, cannulation procedure, post-arrest management, complications, survival and neurologic outcomes were retrospectively reviewed. Results: A total of 24 ECPR events were identified. The median age was 60 years. The median CPR duration and time from collapse to initiation of ECMO were 35 (IQR 25.5-68) and 68 (IQR 45.5-144.5) min, respectively. Peripheral and central access sites were employed in 19 and 5 cases, respectively. Return of spontaneous circulation was achieved in 21 patients (87.5%). PCI was performed on 4 and pulmonary embolectomy on 3 patients. Median duration of ECMO support was 84 (IQR 24-168) hours. Major complications occurred in 17 patients (70.8%). Nine patients (37.5%) were successfully weaned from ECMO and 7 (29.2%) survived to hospital discharge. All of the survivors had a favorable neurologic outcome. Conclusions: ECPR as part of a comprehensive multi-faceted approach for select patients with refractory cardiac arrest may improve outcomes. We noted an improvement in outcomes over time. This could be attributed to improved selection criteria as well as clinical management. The development of selection criteria may help identify patients most likely to benefit from the use of ECPR. This would have significant resource implications for hospitals with ECMO programs.

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Cost-Effectiveness Of Extracorporeal Cardiopulmonary Resuscitation In Patients With Refractory Cardiac Arrest

Value in Health ◽

10.1016/j.jval.2014.08.1435 ◽

2014 ◽

Vol 17 (7) ◽

pp. A488 ◽

Cited By ~ 2

Author(s):

K. Buriskova ◽

V. Rogalewicz ◽

P. Ostadal

Keyword(s):

Cardiac Arrest ◽

Cost Effectiveness ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Refractory Cardiac Arrest

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Refractory cardiac arrrest treated with extracorporeal cardiopulmonary resuscitation, 2-year follow-up

European Heart Journal ◽

10.1093/ehjci/ehaa946.1820 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Kruger ◽

P Ostadal ◽

M Janotka ◽

J Naar ◽

D Vondrakova ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Clinical Outcomes ◽

Blood Lactate ◽

Life Support ◽

Extracorporeal Life Support ◽

Funding Source ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Lactate Levels ◽

Refractory Cardiac Arrest

Abstract Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) has been introduced as a life-saving procedure in refractory cardiac arrest. Methods Eligible patients for this analysis had to undergo ECPR after unsuccessful cardiopulmonary resuscitation with a minimum of three defibrillation attempts. For extracorporeal life support (ECLS) was used Cardiohelp system or Levitronix CentriMag blood pump. LUCAS II system was used for chest compressions during cardiac arrest. The relations of blood lactate and pH levels, measured before ECPR insertion and after 24 hours as well as comorbities (diabetes, hypertension, BMI) to the clinical outcomes at 2 years were evaluated. Results We analyzed data from 59 patients treated with ECPR for refractory cardiac arrest. The mean age of our patients was 61 years. Out-of-hospital cardiac arrest (OHCA) occurred in 33 patients, 26 patients suffered from in-hospital arrest (IHCA). Baseline value of lactate was 11.57±4.22 mmol/l, initial pH 6.95±0.31. In comparison with survivors, patients who died had significantly higher initial lactate levels (12.05±0.81 vs. 8.01±0.77; P<0.05). Moreover, survivors had significantly lower lactate levels after 24 hours (7.39 vs 2.56) and lower BMI (27.4 vs 31.2; P<0.05). Diabetes or hypertension in our group have no influence on the mortality. The difference of mortality in the group of OHCA or IHCA was also not significant. 32% patients survived one month with good neurological outcome (CPC 1–2), 30% six months, 23% one year and 21% two years. Conclusions ECPR give the last chance to survive refractory cardiac arrest. The levels of blood lactate are significantly associated with clinical outcomes of ECPR. Obesity was associated with significantly higher mortality in our group. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): MH CZ DRO (Nemocnice Na Homolce - NNH, 00023884)

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