Predictors of Favorable Neurologic Outcomes in a Territory-First Extracorporeal Cardiopulmonary Resuscitation Program

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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Optimal Mean Arterial Pressure for Favorable Neurological Outcomes in Survivors after Extracorporeal Cardiopulmonary Resuscitation

Journal of Clinical Medicine ◽

10.3390/jcm11020290 ◽

2022 ◽

Vol 11 (2) ◽

pp. 290

Author(s):

Yun Im Lee ◽

Ryoung-Eun Ko ◽

Jeong Hoon Yang ◽

Yang Hyun Cho ◽

Joonghyun Ahn ◽

...

Keyword(s):

Mean Arterial Pressure ◽

Cardiopulmonary Resuscitation ◽

Arterial Pressure ◽

Neurological Status ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurological Outcomes ◽

Neurologic Outcomes ◽

Scale Range ◽

Ensemble Algorithms ◽

Observation Times

We evaluated the optimal mean arterial pressure (MAP) for favorable neurological outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Adult patients who underwent ECPR were included. The average MAP was obtained during 6, 12, 24, 48, 72, and 96 h after cardiac arrest, respectively. Primary outcome was neurological status upon discharge, as assessed by the Cerebral Performance Categories (CPC) scale (range from 1 to 5). Overall, patients with favorable neurological outcomes (CPC 1 or 2) tended to have a higher average MAP than those with poor neurological outcomes. Six models were established based on ensemble algorithms for machine learning, multiple logistic regression and observation times. Patients with average MAP around 75 mmHg had the least probability of poor neurologic outcomes in all the models. However, those with average MAPs below 60 mmHg had a high probability of poor neurological outcomes. In addition, based on an increase in the average MAP, the risk of poor neurological outcomes tended to increase in patients with an average MAP above 75 mmHg. In this study, average MAPs were associated with neurological outcomes in patients who underwent ECPR. Especially, maintaining the survivor’s MAP at about 75 mmHg may be important for neurological recovery after ECPR.

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Neurologic Outcomes in Patients Who Undergo Extracorporeal Cardiopulmonary Resuscitation

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2019.03.033 ◽

2019 ◽

Vol 108 (3) ◽

pp. 749-755 ◽

Cited By ~ 12

Author(s):

Jeong-Am Ryu ◽

Chi Ryang Chung ◽

Yang Hyun Cho ◽

Kiick Sung ◽

Kyeongman Jeon ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurologic Outcomes

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Clinical Significance of Low-Flow Time in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: Results from the RESCUE Registry

Journal of Clinical Medicine ◽

10.3390/jcm9113588 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3588

Author(s):

Ik Hyun Park ◽

Jeong Hoon Yang ◽

Woo Jin Jang ◽

Woo Jung Chun ◽

Ju Hyeon Oh ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Limb Ischemia ◽

Flow Time ◽

Low Flow ◽

Limited Data ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurologic Outcomes ◽

Risk Of Mortality ◽

Hospital Cardiac Arrest ◽

Rescue Procedure

Limited data are available on the association between low-flow time and survival in patients with in-hospital cardiac arrest (IHCA) who undergo extracorporeal cardiopulmonary resuscitation (ECPR). We evaluated data from 183 IHCA patients who underwent ECPR as a rescue procedure. Patients were divided into two groups: patients undergoing extracorporeal membrane oxygenation as an adjunct to standard cardiopulmonary resuscitation for less than 38 min (n = 110) or for longer than 38 min (n = 73). The ECPR ≤ 38 min group had a significantly greater incidence of survival to discharge compared to the ECPR > 38 min group (40.0% versus 24.7%, p = 0.032). The incidence of good neurologic outcomes at discharge tended to be greater in the ECPR ≤ 38 min group than in the ECPR > 38 min group (35.5% versus 24.7%, p = 0.102). The incidences of limb ischemia (p = 0.354) and stroke (p = 0.805) were similar between the two groups, but major bleeding occurred less frequently in the ECPR ≤ 38 min group compared to the ECPR > 38 min group (p = 0.002). Low-flow time ≤ 38 min may reduce the risk of mortality and fatal neurologic damage and could be a measure of optimal management in patients with IHCA.

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