Eligibility criteria for extracorporeal cardiopulmonary resuscitation at Auckland City Hospital: A retrospective cohort study

2020 ◽  
Vol 32 (6) ◽  
pp. 960-966 ◽  
Author(s):  
Michael Iwashita ◽  
Steve Waqanivavalagi ◽  
Tobias Merz ◽  
Peter Jones
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
City Hospital ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation

scholarly journals Prompt extracorporeal cardiopulmonary resuscitation with left ventricular unloading by IMPELLA improves the outcome of patients with refractory cardiac arrest: A single-site retrospective cohort study

2021 ◽  
Author(s):  
Takashi Unoki ◽  
Yudai Tamura ◽  
Motoko Hirai ◽  
Hiroto Suzuyama ◽  
Masayuki Inoue ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Clinical Outcome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Left Ventricular ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Va Ecmo ◽  
Refractory Cardiac Arrest

Abstract Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest (CA). However, VA-ECMO increases damaged left ventricular (LV) afterload. The percutaneous microaxial pump Impella can reduce LV preload with simultaneous circulatory support, which may have a significant effect on clinical outcome by concomitant use of VA-ECMO and IMPELLA (ECPELLA). In the current retrospective cohort study, we assessed factors affecting the outcome of CA patients who underwent E-CPR.Method: We retrospectively reviewed 149 consecutive CA patients with E-CPR from January 2012 through December 2020 in our institute. Patients were divided into three groups: ECEPLLA (n=29), IABP + VA-ECMO (n=78), and single VA-ECMO (n=42). We assessed 30-day survival and neurological outcome using cerebral performance categories (CPCs).Results: There were no significant differences in age, sex, out-of-hospital CA, or acute coronary syndrome among the groups. ECPELLA showed the highest cumulative 30-day survival (ECPELLA: 55%, IABP + VA-ECMO: 23%, VA-ECMO: 9.5; p=0.001) and the rates of CPC score 1 or 2 (ECPELLA: 31%, IABP + VA-ECMO: 13%, VA-ECMO: 7%; p=0.02). Multivariate analysis revealed that age (hazard ratio [HR], 1.30, 95% confidence interval [CI], 1.13-1.52, P=0.005) and time from CA to ECMO support (HR, 1.22, 95% CI, 1.13-1.31, P<0.0001) and ECPELLA (HR, 0.46, 95% CI, 0.24-0.88, P=0.02) were significantly associated with the clinical outcome.Conclusion: Earlier initiation of E-CPR is critical to improve patient survival and neurological outcome. Additional Impella support, ECPELLA, appears to significantly improve the clinical outcome.

scholarly journals Prompt Extracorporeal Cardiopulmonary Resuscitation with Left Ventricular Unloading by IMPELLA Improves Outcome of Patients with Refractory Cardiac Arrest: A Single-Site Retrospective Cohort Study

2021 ◽  
Author(s):  
Takashi Unoki ◽  
Yudai Tamura ◽  
Motoko Hirai ◽  
Hiroto Suzuyama ◽  
Masayuki Inoue ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Clinical Outcome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Left Ventricular ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Va Ecmo ◽  
Refractory Cardiac Arrest

Abstract Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest (CA). However, VA-ECMO increases damaged left ventricular (LV) afterload. The percutaneous microaxial pump, Impella, can reduce LV preload with simultaneous circulatory support, which may have significant effect on clinical outcome by concomitant use of VA-ECMO and IMPELLA (ECPELLA). In the current retrospective cohort study, we assessed factors affecting outcome of CA patients who underwent E-CPR.Method: We retrospectively reviewed 149 consecutive CA patients with E-CPR from January 2012 through December 2020 in our institute. Patients were divided into three groups, ECEPLLA (n=29), IABP + VA-ECMO (n=78), and single VA-ECMO (n=42). We assessed 30-day survival and neurological outcome using the Cerebral Performance Categories (CPC). Results: There were no significant differences in age, gender, out of hospital CA, acute coronary syndrome among groups. The ECPELLA showed the highest cumulative 30-day survival (ECPELLA: 55%, IABP + VA-ECMO: 23%, VA-ECMO: 9.5; p=0.001) and the rates of CPC score 1 or 2 (ECPELLA: 31%, IABP + VA-ECMO: 13%, VA-ECMO: 7%; p=0.02). Multivariate analysis revealed that age (hazard ratio [HR], 1.30, 95% confidence interval [CI], 1.13-1.52, P=0.005) and Time from CA to ECMO support (HR, 1.22, 95%CI, 1.13-1.31, P<0.0001) and ECPELLA (HR, 0.46, 95%CI, 0.24-0.88, P=0.02) were significantly associated with the clinical outcome. Conclusion: Earlier initiation of E-CPR is critical to improve patient survival and neurological outcome. Additional Impella support, ECPELLA, appears to significantly improve the clinical outcome.

scholarly journals Association between neutropenia and death rate of bacterial neonatal sepsis

2016 ◽  
Vol 48 (5) ◽  
pp. 284
Author(s):  
Elly Noer Rochmah ◽  
Ekawaty Lutfia Haksari ◽  
Sri Mulatsih
Keyword(s):  
Developing Countries ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Neonatal Sepsis ◽  
Death Rate ◽  
Retrospective Cohort ◽  
Bacterial Sepsis ◽  
Eligibility Criteria ◽  
Death Risk ◽  
Crucial Problem

Background Neonatal sepsis remains a crucial problem with highmorbidity and mortality. Not less than four million neonates dieevery year, 99% of which occur in developing countries withinfection as the main cause (36%) of death. The prognosticfactors of bacterial neonatal sepsis vary. However the death ratein neonatal sepsis with neutropenia is suspected to be higher thanthat in non-neutropenic condition.Objectives The purpose of this study was to identify whetherneutropenia would increase the death risk of bacterial neonatalsepsis.Methods We conducted a retrospective cohort study. Subjectswere neonates at Instalasi Maternal Perinatal (IMP) of Dr. SardjitoHospital in Yogyakarta who met the eligibility criteria. Duringthe five-year period Qanuary 2002- January 2007), out of 1821cases of suspected neonatal sepsis, 365 (16.7%) were found tohave bacterial cause in the culture of body's fluid (blood, urine,and cerebrospinal). Out of these 16.7% patients suffering fromneutropenia, 39.6% patients died, whereas 9.1 o/o patients weresurvive [RR 4.72, (95% CI: 2.49 to 8.93), P < 0.01].Conclusion Neonates suffering bacterial sepsis with neutropeniahad death risk 4.7 times higher than those who did not haveneutropenia.

Management of thunderclap headache in the emergency room: A retrospective cohort study

Cephalalgia ◽  
2021 ◽  
pp. 033310242098172
Author(s):  
David García-Azorín ◽  
Nuria González-García ◽  
Jaime Abelaira-Freire ◽  
Alberto Marcos-Dolado ◽  
Ángel Luis Guerrero ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Headache ◽  
Final Diagnosis ◽  
Thunderclap Headache ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Eligibility Criteria

Introduction The evaluation of red flags is crucial for the accurate the diagnosis of headache disorders, especially for thunderclap headache. We analysed if secondary headache disorders were adequately ruled out in patients that presented to the emergency room with thunderclap headache. Methods In this retrospective cohort study, we screened all patients that visited the emergency room for headache, including those that described thunderclap headache. We measured the frequency with which secondary causes were not adequately ruled out. We analysed the order of the exams, the final diagnosis, and the time elapsed between arrival, initial request for imaging, and the completion of the imaging. Results We screened 2132 patients, and 42 (1.9%) fulfilled eligibility criteria. Mean age was 43.1 ± 17.1 years, and 57% of patients were female. For 22 (52.4%) patients, the work-up was incomplete. Vascular study was missing in 16 (38.1%) patients, cerebrospinal fluid evaluation in nine (21.4%), and magnetic resonance imaging in seven (16.7%), with multiple assessments missing in six (14.3%). There were ten different combinations in which the exams were performed, with the most frequent being the second exam’s cerebral spinal fluid evaluation in 18 (52.9%) and the computed tomography angiogram in 10 (29.4%). A secondary cause of thunderclap headache was found in 16 (38.1%) patients, and four (9.5%) had a primary headache diagnosis after an adequate and complete study. Conclusions Thunderclap onset was described in one of every 50 patients that visited the emergency room for headache. More than half of these patients were not adequately managed. More than a third of thunderclap headache patients had a secondary cause.

Sign in / Sign up

Export Citation Format

Share Document