P2751D-dimer levels on admission predict a bleeding complication in out-of-hospital cardiac arrest patients resuscitated with extracorporeal membrane oxygenation

Introduction: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) has poor outcome. Data about use of extracorporeal membrane oxygenation (ECMO) in PE are heterogenous and there is minimal evidence for its use in patients presenting with r-OHCA. Hypothesis: To describe in detail profile, initial settings of cardiac arrest (CA) and clinical course of patients with PE presenting with r-OHCA and its specifics in comparison to patients with r-OHCA of other cause. The special attention was paid to the use of ECMO and its potential benefit for patient prognosis. Methods: We reanalyzed subgroup of patients with PE from Prague OHCA study - a randomized control trial evaluating the effect of hyperinvasive approach including the use of ECMO in r-OHCA. Patients characteristics, the specifics of CA settings and the outcome were compared to the patients with other cause of r-OHCA. The neurologically favorable survival was then compared between PE patients randomized to Hyperinvasive and Standard arm of the study. Results: The PE was identified as a cause of CA in 24 (9.4 %) patients in Prague OHCA study. PE patients were more likely women (12 [50 %] vs 32 [13.8 %]) with non-shockable initial rhythm (23 [95.8 %] vs 77 [33.2 %]; P < 0.0001). The CA occurs more frequently after arrival of emergency medical service (14 [58.3 %], vs 22 [9.5 %]; P < 0.0001), had shorter time to hospital admission (median in minutes [IQR], 40 [34.5-57.8] vs 54 [46-64]; P = 0.01) with more severe acidosis at admission (median pH [IQR]; 6.83 [6.75-6.88] vs 6.98 [6.82-7.14] P = 0.0008). The primary outcome of patients with PE - CPC 1 or 2 at 180 days - was significantly worse (2 [8.3 %] vs 66 [28.4 %]; P = 0.049). There was non-significant difference in primary outcome - CPC 1 or 2 at 180 days - between PE patients in Hyperinvasive (12 [50%]) and Standard arm of the study (2 [16.7 %] vs 0; P = 0.24). Conclusion: The initial profile of patients and the settings of CA in patients with r-OHCA and PE differs from patients with other CA cause and their prognosis is significantly worse. The Hyperinvasive approach did not improved outcome in this subgroup of patients.

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LO68: Extracorporeal membrane oxygenation in the emergency department for resuscitation of out-of-hospital cardiac arrest patients: a systematic review

CJEM ◽

10.1017/cem.2017.130 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S51

Author(s):

M.M. Beyea ◽

B.W. Tillmann ◽

A.E. Lansavichene ◽

V. Randhawa ◽

K. Van Aarsen ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Cohort Studies ◽

Hospital Discharge ◽

Case Series ◽

Inclusion Criteria ◽

Neurologic Recovery ◽

Membrane Oxygenation ◽

Hospital Cardiac Arrest

Introduction: With one person in Canada suffering an out-of-hospital cardiac arrest (OHCA) every 12 minutes and an estimated survival to hospital discharge with good neurologic function ranging from 3 to 16%, OHCA represents a major source of morbidity and mortality. An evolving adjunct for resuscitation of OHCA patients is the use of extracorporeal membrane oxygenation-assisted CPR (ECPR). The purpose of this systematic review is to investigate the survival to hospital discharge with good neurologic recovery in patients suffering from OHCA treated with ECPR compared to those who received standard advanced cardiac life support with conventional CPR (CCPR) alone. Methods: A systematic database search of both MEDLINE & EMBASE was performed up until September 2016 to identify studies with ≥5 patients reporting ECPR use in adults (age ≥16 years) with OHCA. Only studies reporting survival to hospital discharge were included. All identified studies were assessed independently using pre-determined inclusion criteria by two reviewers. Study quality and risk of bias were evaluated using the Newcastle Ottawa regulations assessment scale. Results: Of the 1065 records identified, 54 studies met all inclusion criteria. Inter-rater reliability was high with a kappa statistic of 0.85. The majority of studies were comprised of case series (n=45) of ECPR with 5 to 83 patients/study. Out of the 45 case series, 37 presented neurologic data at hospital discharge and demonstrated a broad range of patients surviving with good neurologic outcome (0 to 71.4%). Only 9 cohort studies with relevant control group (CCPR) were identified (38 to 21750 patients/study). Preliminary analysis demonstrated that 6 cohort studies were sufficient quality to compare ECPR to CCPR. All 6 studies showed significantly increased survival to hospital discharge with good neurologic recovery (ECPR 10.6 to 41.6% vs CCPR 1.5 to 7.7%, respectively). Conclusion: Given the paucity of studies using appropriate comparators to evaluate the impact of ECMO, our confidence in a clinically relevant difference in outcomes compared to current standards of care for OHCA remains weak. Interestingly, a limited number of studies with suitable controls demonstrated a potential benefit associated with ECPR in the management of OHCA in selected patients. In this state of equipoise, high quality RCT data is urgently needed.

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EXTRACORPOREAL MEMBRANE OXYGENATION-ASSISTED CARDIOPULMONARY RESUSCITATION IMPROVES BRAIN OXYGENATION DURING IN-HOSPITAL CARDIAC ARREST

CHEST Journal ◽

10.1016/j.chest.2019.08.262 ◽

2019 ◽

Vol 156 (4) ◽

pp. A196

Author(s):

Emma Roellke ◽

Amanda Mengotto ◽

Tori Williams ◽

Sam Parnia

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Membrane Oxygenation ◽

Brain Oxygenation ◽

Membrane Oxygenation ◽

Hospital Cardiac Arrest

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342Duration for attaining favourable neurological outcome in refractory out-of-hospital cardiac arrest patients who were resuscitated with veno-arterial extracorporeal membrane oxygenation

European Heart Journal ◽

10.1093/eurheartj/ehx501.342 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

T. Otani ◽

R. Matsuoka ◽

M. Morita ◽

T. Natsukawa ◽

H. Sawano ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Neurological Outcome ◽

Membrane Oxygenation ◽

Hospital Cardiac Arrest

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P109: Identifying patients who may benefit from extracorporeal membrane oxygenation (ECMO) after cardiac arrest in the urban emergency departments of Saskatchewan

CJEM ◽

10.1017/cem.2016.284 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S114-S115

Author(s):

P. Robinson ◽

K. Sharanowski ◽

N. Lalani ◽

S. Harenberg ◽

K. Lyster

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Emergency Departments ◽

Critical Mass ◽

Trauma Patients ◽

Exclusion Criteria ◽

Treatment Protocols ◽

Membrane Oxygenation ◽

Mechanical Cpr ◽

Hospital Cardiac Arrest

Introduction: Emergency physician-initiated Extracorporeal Membrane Oxygenation (ECMO/ECPR/ECLS) is gaining critical mass as a successful rescue strategy for patients requiring resuscitation. Wang et al. (2014), Bellezzo et al. (2012) and others have demonstrated promising results of survival to discharge with good neurological function in patients who were resistant to existing treatment protocols after out-of-hospital cardiac arrest. As Saskatchewan does not yet utilize ECMO for cardiac arrest, the objective of this study was to examine the number of adult cardiac arrest patients in the urban emergency departments (EDs) of Saskatchewan who may benefit from the use of ECMO. Methods: Using a retrospective review, we identified 401 patients who died after presenting with cardiac arrest between January 1st, 2013 and December 31st, 2014. Of the original 401, 136 were female and 264 were male, with a mean age of 60.1±20.2 years. The charts of 22 (5.5%) trauma patients were excluded because the suitability of ECMO in these patients is uncertain. Results: For the 379 non-trauma patients, the mean resuscitation length was 41.6±32.8 minutes (median=42 minutes) and 125 of these patients received prehospital mechanical CPR. We applied Bellezzo et al.’s (2012) inclusion and exclusion criteria to identify prospective candidates for ECMO. In total, 53 patients (14.0%) with a mean age of 57.1±13.4 years old, represent suitable candidates for ECMO. 260 (68.6%) were deemed unsuitable either because they failed the inclusion criteria or met explicit exclusion criteria. The remainder (66 [17.4%]) were unsuitable because of age. Conclusion: With 1 in 7 patients potentially representing suitable candidates for ECMO, this is a technique that warrants consideration for implementation in the EDs of Saskatchewan.

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Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2021.21238 ◽

2021 ◽

Vol 29 (3) ◽

pp. 311-319

Author(s):

Mustafa Emre Gürcü ◽

Şeyhmus Külahçıoğlu ◽

Pınar Karaca Baysal ◽

Serdar Fidan ◽

Cem Doğan ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Membrane Oxygenation ◽

Left Ventricular Ejection ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurological Outcomes ◽

Coronary Syndrome ◽

Membrane Oxygenation ◽

Hospital Cardiac Arrest

Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients. Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded. Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%. Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

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