scholarly journals Extracorporeal resuscitation with carbon monoxide improves renal function by targeting inflammatory pathways in cardiac arrest in pigs

2019 ◽  
Vol 317 (6) ◽  
pp. F1572-F1581 ◽  
Author(s):  
Jakob Wollborn ◽  
Bjoern Schlueter ◽  
Christoph Steiger ◽  
Cornelius Hermann ◽  
Christian Wunder ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Renal Function ◽  
Cardiac Arrest ◽  
Renal Injury ◽  
Porcine Model ◽  
Life Support ◽  
Apoptotic Cell ◽  
Extracorporeal Life Support ◽  
Successful Resuscitation ◽  
Extracorporeal Resuscitation

Deleterious consequences like acute kidney injury frequently occur upon successful resuscitation from cardiac arrest. Extracorporeal life support is increasingly used to overcome high cardiac arrest mortality. Carbon monoxide (CO) is an endogenous gasotransmitter, capable of reducing renal injury. In our study, we hypothesized that addition of CO to extracorporeal resuscitation hampers severity of renal injury in a porcine model of cardiac arrest. Hypoxic cardiac arrest was induced in pigs. Animals were resuscitated using a conventional [cardiopulmonary resuscitation (CPR)], an extracorporeal (E-CPR), or a CO-assisted extracorporeal (CO-E-CPR) protocol. CO was applied using a membrane-controlled releasing system. Markers of renal injury were measured, and histopathological analyses were carried out. We investigated renal pathways involving inflammation as well as apoptotic cell death. No differences in serum neutrophil gelatinase-associated lipocalin (NGAL) were detected after CO treatment compared with Sham animals (Sham 71 ± 7 and CO-E-CPR 95 ± 6 ng/mL), while NGAL was increased in CPR and E-CPR groups (CPR 135 ± 11 and E-CPR 124 ± 5 ng/mL; P < 0.05). Evidence for histopathological damage was abrogated after CO application. CO increased renal heat shock protein 70 expression and reduced inducible cyclooxygenase 2 (CPR: 60 ± 8; E-CPR 56 ± 8; CO-E-CPR 31 ± 3 µg/mL; P < 0.05). Caspase 3 activity was decreased (CPR 1,469 ± 276; E-CPR 1,670 ± 225; CO-E-CPR 755 ± 83 pg/mL; P < 0.05). Furthermore, we found a reduction in renal inflammatory signaling upon CO treatment. Our data demonstrate improved renal function by extracorporeal CO treatment in a porcine model of cardiac arrest. CO reduced proinflammatory and proapoptotic signaling, characterizing beneficial aspects of a novel treatment option to overcome high mortality.

scholarly journals Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Melanie Kuhnke ◽  
Roland Albrecht ◽  
Joerg C. Schefold ◽  
Peter Paal
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Core Temperature ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Weather Conditions ◽  
Successful Resuscitation ◽  
Case Presentation ◽  
Favorable Neurological Outcome ◽  
Level 1 Trauma Center

Abstract Background We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. Case presentation A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery. Conclusions Successful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available.

scholarly journals Deep Hypothermic Cardiac Arrest Treated by Extracorporeal Life Support in a Porcine Model: Does the Rewarming Method Matter?

2016 ◽  
Vol 23 (6) ◽  
pp. 665-673 ◽  
Author(s):  
Guillaume Debaty ◽  
Maxime Maignan ◽  
Bertrand Perrin ◽  
Angélique Brouta ◽  
Dorra Guergour ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Porcine Model ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Deep Hypothermic Cardiac Arrest

Survival and Factors Associated with Survival with Extracorporeal Life Support During Cardiac Arrest

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Vassili Panagides ◽  
Marc Laine ◽  
Guillaume Fond ◽  
Guillaume Lebreton ◽  
Franck Paganelli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Factors Associated

scholarly journals Reply to: The role of extracorporeal life support in patients with hypothermic cardiac arrest

Resuscitation ◽  
2019 ◽  
Vol 134 ◽  
pp. 159-160
Author(s):  
Michael M. Beyea ◽  
Bourke W. Tillmann ◽  
A. Dave Nagpal
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support

scholarly journals Survival and quality of life after extracorporeal life support for refractory cardiac arrest: A case series

2015 ◽  
Vol 150 (4) ◽  
pp. 947-954 ◽  
Author(s):  
Amedeo Anselmi ◽  
Erwan Flécher ◽  
Hervé Corbineau ◽  
Thierry Langanay ◽  
Vincent Le Bouquin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Series ◽  
Refractory Cardiac Arrest

Abstract 19091: Prognosis of Patients With Out-of-hospital Refractory Cardiac Arrest Referred for Extracorporeal Life Support: An Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cecile Ursat ◽  
Marie-Ange Tilliette ◽  
Charles Groizard ◽  
Margot Cassuto ◽  
Anna Ozguler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Time Interval ◽  
Specific Situation ◽  
Time Intervals ◽  
Paris Area

Introduction: In case of no return of spontaneous circulation (ROSC) after conventional cardio-pulmonary resuscitation (CPR), out-of-hospital cardiac arrest (OHCA) patients could be referred for extracorporeal life support (ECLS). Guidelines have been published concerning this specific situation (1). The aim of our study was to describe the prognosis of OHCA patients and verify if referral to ECLS was compliant with these recommendations mainly studying time intervals (no-flow < 5 min, low-flow < 100 min). Methods: A prospective survey on OHCA referred to ECLS was implemented from 03/01/12 until 06/11/15 in an Emergency Medical Service (EMS) located in Paris area (France). This survey included 43 patients referred to hospital for ECLS. Variables were given as means and percentages. Results: Patients referred to ECLS were more often men (77%), with a mean age of 51 years old. Most of 43 OHCA occurred at home (51%), although 26% occurred on public area and 16% at workplace. In 40% of cases, CPR was performed by a witness and in 33% by a health professional. A first Basic Life Support ambulance arrived on scene within 7 min 50 sec, whereas EMS ambulance arrived on scene within 18 min 27 sec after OHCA. At EMS arrival on scene, patients were on asystole (44%), ventricular fibrillation (37%), and on spontaneous circulation (12%). The no-flow time interval was 4 min 10 sec on average (6 patients had a no-flow over 5 min) with 43% of patients with no no-flow. Low-flow time-interval was 44 min. External electric shock was delivered before EMS arrival on 21% of cases, and EMS itself delivered a shock in 40% of cases. Epinephrine was used for all patients, 10.35 mg on average. No patient survived OHCA after referral to ECLS. Discussion: Although this is a small series of 43 patients, no OHCA patient referred to ECLS survived. These results are mainly due to a non-shockable initial condition or too long no-flow time intervals. In order to improve the outcome and bring benefit to the proper expected patients through a cost-effective pathway, we released a reminder of the right recommendations in our EMS. (1) Riou B., Adnet F., Baud F et al. A. Recommandation sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Réanim 2009 ; 28 : 182-6.

Abstract 16064: Mechanical Left Ventricular Venting is Associated With Improved Survival in Adults Undergoing Venoarterial Extracorporeal Life Support: An ELSO Registry Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jose I Nunez ◽  
Brooks Willar ◽  
Kevin Kennedy ◽  
Peter Rycus ◽  
Joseph Tonna ◽  
...  
Keyword(s):  
Adverse Events ◽  
Renal Injury ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Limb Ischemia ◽  
Aortic Disease ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Clinical Covariates ◽  
Central Cannulation

Introduction: Venoarterial extracorporeal life support (VA-ECLS) imposes increased afterload on the left ventricle (LV), potentially provoking LV distension and impaired ventricular recovery. Prior studies have suggested a survival benefit with LV mechanical venting (MV), but multi-center data are lacking. Methods: We queried the ELSO registry for adults undergoing VA-ECLS and stratified them by the use of MV, including intra-aortic balloon pump and percutaneous ventricular assist device. We excluded patients with pulmonary embolism, heart transplant, congenital and valvular heart disease, aortic disease, and central cannulation. The primary outcome was in-hospital mortality. Secondary outcomes were on-support mortality and major adverse events, including bleeding, hemolysis, ischemic stroke, limb ischemia, and renal injury. We used multivariable logistic regression modeling to adjust for relevant clinical covariates. Results: Among 12734 patients undergoing VA-ECLS, 3353 (26.3%) received MV devices. Patients with MV were older (mean age 56.3 vs 52.7 years), more often male (76.3% vs 68.5%), and more often supported for acute myocardial infarction (43.0% vs 21.7%), p<0.001 for all. Prior to ECLS, patients with MV had lower rates of cardiac arrest (51.7% vs 55.1%) but more commonly needed >2 vasopressors (41.8% vs 27.2%) and had a higher incidence of acute renal (17.1% vs 10.5%), liver (4.4% vs 3.1%), and respiratory failure (20.9% vs 15.9%), p<0.001 for all. Crude on-support (41.6% vs 47.8%, p<0.001) and in-hospital (56.7% vs 59.2%, p=0.01) mortality were lower in the MV group. In multivariable modeling, MV was associated with a significantly lower odds of mortality but higher odds of adverse events including medical and cannula site bleeding, hemolysis, limb ischemia and renal injury (Figure). Conclusions: Among adults supported with peripheral VA-ECLS, LV MV was associated with lower mortality despite a higher rate of important adverse events.

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