Outcome in potential candidates for extracorporeal cardiopulmonary resuscitation after refractory out-of-hospital cardiac arrest treated with conventional advanced life support

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

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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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Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Membranes ◽

10.3390/membranes11040270 ◽

2021 ◽

Vol 11 (4) ◽

pp. 270

Author(s):

Viviane Zotzmann ◽

Corinna N. Lang ◽

Xavier Bemtgen ◽

Markus Jaeckel ◽

Annabelle Fluegler ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Cerebral Damage ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Refractory Shock ◽

Lactate Levels ◽

Mode Of Death

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.

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Does ‘heads-up’ cardiopulmonary resuscitation improve outcomes for patients in out-of-hospital cardiac arrest? A systematic review

British Paramedic Journal ◽

10.29045/14784726.2020.12.4.4.16 ◽

2020 ◽

Vol 4 (4) ◽

pp. 16-24

Author(s):

Andrew Elphinstone ◽

Samantha Laws

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Animal Studies ◽

Life Support ◽

Survival Rates ◽

Advanced Life Support ◽

Coronary Perfusion Pressure ◽

Coronary Perfusion ◽

Hospital Cardiac Arrest

Introduction: Survival rates for patients in out-of-hospital cardiac arrest have remained around 10% in the United Kingdom for the past seven years. If outcomes are to be improved, research into new methods of advanced life support is required. One such method may be ‘heads-up’ cardiopulmonary resuscitation.Methods: A systematic review of literature exploring heads-up cardiopulmonary resuscitation was conducted in an attempt to identify its effects on survival to discharge and neurological outcome.Results: A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Six papers were classed as sufficiently relevant for inclusion. Included studies were generally of low quality and none studied the effect of heads-up cardiopulmonary resuscitation on out-of-hospital cardiac arrest patients. Animal studies identified a significant reduction in intracranial pressure and increase in cerebral and coronary perfusion pressure for use of augmented heads-up cardiopulmonary resuscitation in the porcine model of cardiac arrest.Conclusion: Further research is required to analyse the effects and potential benefits of augmented heads-up cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

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Healthcare professionals’ knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119900075 ◽

2020 ◽

Vol 19 (5) ◽

pp. 401-410

Author(s):

Christos Kourek ◽

Robert Greif ◽

Georgios Georgiopoulos ◽

Maaret Castrén ◽

Bernd Böttiger ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Healthcare Professionals ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

European Countries ◽

University Hospitals ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

Background: In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. Aims: The purpose of this study was to assess healthcare professionals’ knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. Methods and results: A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support ( P=0.005) while Belgium hospitals scored highest on advanced life support ( P<0.001) and total score in cardiopulmonary resuscitation knowledge ( P=0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training ( P<0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P<0.001). Conclusion: Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients’ return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates.

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The effect of extracorporeal cardiopulmonary resuscitation in re-arrest after survival event: a retrospective analysis

Perfusion ◽

10.1177/0267659119850679 ◽

2019 ◽

Vol 35 (1) ◽

pp. 39-47

Author(s):

Kap Su Han ◽

Su Jin Kim ◽

Eui Jung Lee ◽

Sung Woo Lee

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Retrospective Analysis ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Alternative Methods ◽

Multiple Logistic Regression ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

Background: The objectives of this study were to 1) identify the risk factors for predicting re-arrest and 2) determine whether extracorporeal cardiopulmonary resuscitation results in better outcomes than conventional cardiopulmonary resuscitation for managing re-arrest in out-of-hospital cardiac arrest patients. Methods: This retrospective analysis was based on a prospective cohort. We included adult patients with non-traumatic out-of-hospital cardiac arrest who achieved a survival event. The primary measurement was re-arrest, defined as recurrent cardiac arrest within 24 hours after survival event. Multiple logistic regression analysis was used to predict re-arrest. Subgroup analysis was performed to evaluate the effect of extracorporeal cardiopulmonary resuscitation on the survival to discharge in out-of-hospital cardiac arrest patients who experienced re-arrest. Results: Of 534 patients suitable for inclusion, 203 (38.0%) were enrolled in the re-arrest group. Old age, prolonged advanced cardiac life support duration and the presence of hypotension at 0 hours after survival event were independent variables predicting re-arrest. In the re-arrest group, the extracorporeal cardiopulmonary resuscitation group (n = 25) showed better outcomes than the conventional cardiopulmonary resuscitation group. However, multiple logistic regression for predicting survival to discharge revealed that extracorporeal cardiopulmonary resuscitation was not an independent factor. Multiple logistic regression revealed that a hypotensive state at re-arrest was an independent risk factor for survival. Conclusion: Alternative methods that reduce the advanced cardiac life support duration should be considered to prevent re-arrest and attain good outcomes in out-of-hospital cardiac arrest patients. Extracorporeal cardiopulmonary resuscitation for re-arrest tended to show a good outcome compared to conventional cardiopulmonary resuscitation for re-arrest. Avoiding or immediately correcting hypotension may prevent re-arrest and improve the outcome of re-arrested patients.

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Extracorporeal Cardiopulmonary Resuscitation for Management of Out-of-Hospital Cardiac Arrest in a Patient with Fulminant Myocarditis

Case Reports in Critical Care ◽

10.1155/2020/8881042 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Alexander J. Meyer ◽

Michael A. Biersmith ◽

Ernest L. Mazzaferri ◽

Konstantinos Dean Boudoulas

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Acute Myocarditis ◽

Fulminant Myocarditis ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Cardiac Catheterization Laboratory ◽

Va Ecmo ◽

Hospital Cardiac Arrest

A 68-year-old male with a witnessed out-of-hospital cardiac arrest while jogging who was managed with extracorporeal cardiopulmonary resuscitation (ECPR) is presented. The patient was found to be in refractory ventricular fibrillation by emergency medical service personnel and underwent advanced cardiac life support (ACLS) protocol with placement of an automated chest compression device. He was emergently transported to the cardiac catheterization laboratory. Due to refractory ventricular fibrillation, he was placed on venoarterial extracorporeal membranous oxygenation (VA-ECMO). Coronary angiography at that time showed nonobstructive coronary artery disease. Management with VA-ECMO and other supportive measures were continued for 5 days, after which a cardiac magnetic resonance imaging was performed with findings consistent with acute myocarditis. His condition substantially improved, and he was discharged from the hospital with good neurologic and functional status. Fulminant myocarditis is often fatal, but aggressive supportive measures with novel ECPR protocols may result in recovery, as it happened in this case.

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Targeted temperature management in patients undergoing extracorporeal life support after out-of-hospital cardiac arrest: an EURO-ELSO 2018 annual conference survey

Perfusion ◽

10.1177/0267659119847033 ◽

2019 ◽

Vol 34 (8) ◽

pp. 714-716

Author(s):

Caroline Rolfes ◽

Ralf M Muellenbach ◽

Philipp M Lepper ◽

Tobias Spangenberg ◽

Justyna Swol ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support ◽

Bleeding Risk ◽

Targeted Temperature Management ◽

Temperature Management ◽

Annual Conference ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

Targeted temperature management and extracorporeal life support, particularly extracorporeal membrane oxygenation in patients undergoing cardiopulmonary resuscitation, represent outcome-enhancing strategies for patients following in- and out-of-hospital cardiac arrest. Although targeted temperature management with hypothermia between 32°C and 34°C and extracorporeal cardiopulmonary resuscitation bear separate potentials to improve outcome after out-of-hospital cardiac arrest, each is associated with bleeding risk and risk of infection. Whether the combination imposes excessive risk on patients is, however, unknown.

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Extracorporeal Cardiopulmonary Resuscitation for Out‐of‐Hospital Cardiac Arrest in Adult Patients

Journal of the American Heart Association ◽

10.1161/jaha.119.015291 ◽

2020 ◽

Vol 9 (7) ◽

Cited By ~ 3

Author(s):

Akihiko Inoue ◽

Toru Hifumi ◽

Tetsuya Sakamoto ◽

Yasuhiro Kuroda

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support ◽

The United States ◽

Adult Patients ◽

Temperature Management ◽

Secondary Brain Injury ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out‐of‐hospital cardiac arrest (OHCA) in adult patients. Although recent narrative and systematic reviews on extracorporeal life support in the emergency department are available in the literature, they are focused on the efficacy of ECPR, and no comprehensively summarized review on ECPR for OHCA in adult patients is available. In this review, we aimed to clarify the prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, with the aim of facilitating understanding among acute care physicians. The leading countries in the field of ECPR are those in East Asia followed by those in Europe and the United States. ECPR may reduce the risks of reperfusion injury and deterioration to secondary brain injury. Unlike conventional cardiopulmonary resuscitation, however, no clear prognostic markers have been identified for ECPR for OHCA. Bleeding was identified as the most common complication of ECPR in patients with OHCA. Future studies should combine ECPR with intra‐aortic balloon pump, extracorporeal membrane oxygenation flow, target blood pressure, and seizure management in ECPR.

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