Cardiac Arrest and Successful Extracorporeal Cardiopulmonary Resuscitation as a Result of a Refeeding Syndrome in a Young Female with Anorexia Nervosa

Anorexia nervosa is a potentially life-threatening eating disorder, characterized by an abnormally low body weight. This case report illustrates a 22-year old female with cardiac arrest due to a refeeding syndrome in a patient with anorexia nervosa. It features the successful use of extracorporeal cardiopulmonary resuscitation in a case of severe left ventricular dysfunction resulting in a favorable outcome. Conclusion. We present the first case of a cardiac arrest due to a refeeding syndrome in anorexia nervosa featuring the successful use of an extracorporeal cardiopulmonary resuscitation approach as a bridge to full recovery.

Download Full-text

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

10.21203/rs.3.rs-422306/v1 ◽

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.

Download Full-text

Abstract 117: Critical Care Management, Hospital Case Volume, and Survival After Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.117 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Joseph Tonna ◽

Craig Selzman ◽

Jason Bartos ◽

Angela Presson ◽

Yeonjung Jo ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support ◽

Coronary Intervention ◽

Left Ventricular ◽

Case Volume ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Clinical Variables ◽

Hospital Case

Introduction: For patients who receive extracorporeal cardiopulmonary resuscitation (ECPR), the relationship between post-resuscitation management and survival is unknown. Additionally, it is not known if management varies between centers, and if this variation and hospital case volume, are associated with survival. Hypothesis: There is center level variability in post-resuscitation management for ECPR patients. This variability, and hospital annual case volume, are associated with survival. Methods: We performed an observational study of 4,296 adults who received ECPR from the Extracorporeal Life Support Organization registry from 2014 until 2019. We examined clinical variables within the first 24 hours after arrest, and hospital annual ECPR volume. The primary outcome was case-mix adjusted survival at hospital discharge, adjusting for factors previously associated with survival after cardiac arrest or extracorporeal membrane oxygenation (ECMO). Mixed effects regression models were used to account for clustering of outcomes by center. Case volume was stratified into low (<6 cases/year), medium (6-12 cases/year) and high (>12 cases/year). Results: Patient-level clinical variables after cardiac arrest, varied widely across individual hospitals, including the use of percutaneous coronary intervention (PCI), mechanical venting of the left ventricle, and the use of inotropic medications. Increased ECMO circuit blood flow at 4 hours was associated with survival (OR 1.14 per liter per minute of flow [95% CI 1.04 to 1.24];p=0.004). After 24 hours of ECMO, increased arterial pulsatility (OR 1.44 [95% CI 1.32 to 1.58]; p<0.001), the placement of a distal perfusion catheter (OR 1.79 [95% CI 1.19 to 2.67]; p=0.005), and the placement of a mechanical left ventricular vent (OR 1.37 [95% CI 1.07 to 1.76]; p=0.012) were all significantly associated with survival. There was a nonsignificant association of the use of PCI after ECMO cannulation with survival (OR 1.31 [95% CI 0.998 to 1.91]; p=0.051). High case volume was not associated with survival (OR 1.32 [95% CI 0.98 to 1.78];p=0.072). Conclusions: Clinical management of ECPR patients varies across hospitals. These clinical variables and therapies are associated with survival, however center volume is not.

Download Full-text

Effects of extracorporeal cardiopulmonary resuscitation on neurological and cardiac outcome after ischaemic refractory cardiac arrest

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617737041 ◽

2017 ◽

Vol 7 (5) ◽

pp. 432-441 ◽

Cited By ~ 10

Author(s):

Francesca Cesana ◽

Leonello Avalli ◽

Laura Garatti ◽

Anna Coppo ◽

Stefano Righetti ◽

...

Keyword(s):

Cardiac Arrest ◽

Left Ventricular Ejection Fraction ◽

Cardiopulmonary Resuscitation ◽

Spontaneous Circulation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Ventricular Ejection Fraction ◽

Return Of Spontaneous Circulation ◽

Refractory Cardiac Arrest

Background: Extracorporeal cardiopulmonary resuscitation is increasingly recognised as a rescue therapy for refractory cardiac arrest, nevertheless data are scanty about its effects on neurologic and cardiac outcome. The aim of this study is to compare clinical outcome in patients with cardiac arrest of ischaemic origin (i.e. critical coronary plaque during angiography) and return of spontaneous circulation during conventional cardiopulmonary resuscitation vs refractory cardiac arrest patients needing extracorporeal cardiopulmonary resuscitation. Moreover, we tried to identify predictors of survival after successful cardiopulmonary resuscitation. Methods: We enrolled 148 patients with ischaemic cardiac arrest admitted to our hospital from 2011–2015. We compared clinical characteristics, cardiac arrest features, neurological and echocardiographic data obtained after return of spontaneous circulation (within 24 h, 15 days and six months). Results: Patients in the extracorporeal cardiopulmonary resuscitation group ( n=63, 43%) were younger (59±9 vs 63±8 year-old, p=0.02) with lower incidence of atherosclerosis risk factors than those with conventional cardiopulmonary resuscitation. In the extracorporeal cardiopulmonary resuscitation group, left ventricular ejection fraction was lower than conventional cardiopulmonary resuscitation at early echocardiography (19±16% vs 37±11 p<0.01). Survivors in both groups showed similar left ventricular ejection fraction 15 days and 4–6 months after cardiac arrest (46±8% vs 49±10, 47±11% vs 45±13%, p not significant for both), despite a major extent and duration of cardiac ischaemia in extracorporeal cardiopulmonary resuscitation patients. At multivariate analysis, the total cardiac arrest time was the only independent predictor of survival. Conclusions: Extracorporeal cardiopulmonary resuscitation patients are younger and have less comorbidities than conventional cardiopulmonary resuscitation, but they have worse survival and lower early left ventricular ejection fraction. Survivors after extracorporeal cardiopulmonary resuscitation have a neurological outcome and recovery of heart function comparable to subjects with return of spontaneous circulation. Total cardiac arrest time is the only predictor of survival after cardiopulmonary resuscitation in both groups.

Download Full-text

Case Report: Cardiac arrest due to traumatic coronary artery dissection treated by extracorporeal membrane resuscitation

F1000Research ◽

10.12688/f1000research.20123.1 ◽

2019 ◽

Vol 8 ◽

pp. 1720

Author(s):

Kumiko Tanaka ◽

Taka-aki Nakada ◽

Tadayuki Kadohira ◽

Shigeto Oda

Keyword(s):

Cardiac Arrest ◽

Coronary Artery ◽

Cardiopulmonary Resuscitation ◽

Spontaneous Circulation ◽

Left Ventricular ◽

Artery Dissection ◽

Coronary Artery Dissection ◽

Circumflex Artery ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Left Circumflex Artery

Traumatic coronary artery dissection, which is rare in blunt trauma, has high risk of acute myocardial infarction and cardiac arrest. A 44-year-old man who had a traffic accident was transferred to the emergency department with refractory ventricular fibrillation (VF). After conventional cardiopulmonary resuscitation, we introduced extracorporeal cardiopulmonary resuscitation (ECPR) and obtained return of spontaneous circulation with ST-elevation electrocardiogram at V4-6. Subsequent coronary angiography and intravascular ultrasound supported by extracorporeal membrane oxygenation (ECMO) revealed complete occlusions of left anterior descending and left circumflex artery due to dissections. Drug-eluting stents were placed with restorations of TIMI 2 flows. After ICU admission, his left ventricular function gradually recovered; he was successfully weaned from VA-ECMO on day 9. ECPR may be a valuable option to allow time and stable hemodynamic condition to treat the cause of cardiac arrest.

Download Full-text

Extracorporeal cardiopulmonary resuscitation for severe chloroquine intoxication in a child – a case report

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00850-0 ◽

2021 ◽

Vol 29 (1) ◽

Cited By ~ 1

Author(s):

Thomas Ferry ◽

Vivianne Amiet ◽

Julia Natterer ◽

Marie-Hélène Perez ◽

Raymond Pfister ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cardiac Toxicity ◽

Experimental Treatment ◽

Neurological Impairment ◽

The Novel ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Cardio Pulmonary Resuscitation ◽

Life Threatening ◽

Novel Coronavirus

Abstract Background Chloroquine use has increased worldwide recently in the setting of experimental treatment for the novel coronavirus disease (Covid-19). Nevertheless, in case of chloroquine intoxication, it can be life threatening, with cardiac arrest, due to its cardiac toxicity. Case presentation This case study reports on a 14-years-old girl who presented in cardiac arrest after an uncommon suicide attempt by ingesting 3 g of chloroquine. After 66 min of cardio-pulmonary resuscitation (CPR), extracorporeal cardiopulmonary resuscitation (ECPR) was initiated, allowing cardiac function to recover. Conclusions Chloroquine intoxication is a rare but serious condition due to its cardiac toxicity. Use of ECPR in this case of transient toxicity allowed a favorable evolution with little neurological impairment.

Download Full-text

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

10.21203/rs.3.rs-397381/v1 ◽

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.

Download Full-text

Abstract 214: Cardiac Arrest and Extracorporeal Cardiopulmonary Resuscitation Impairs Left Ventricle Hemodynamic Function in a Ventricular Fibrillation Cardiac Arrest Model in Rats

Circulation ◽

10.1161/circ.142.suppl_4.214 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Alexandra Maria Warenits ◽

Matthias Müller ◽

Ingrid Anna Maria Magnet ◽

Florian Ettl ◽

Ouafa Hamza ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiac Output ◽

Ventricular Fibrillation ◽

Cardiopulmonary Resuscitation ◽

Left Ventricular ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hemodynamic Stress ◽

Hemodynamic Function ◽

The Right ◽

The Impact

Introduction: Extracorporeal Cardiopulmonary Resuscitation (ECPR) may achieve ROSC after prolonged CA when conventional cardiopulmonary resuscitation fails. We investigated the impact of ECPR on cardiac hemodynamic recovery and hypothesized, that left ventricular hemodynamic function is impaired in resuscitated hearts. Methods: Adult male Sprague-Dawley rats (500 g, n=36) were subjected to 6 or 8 min of ventricular fibrillation CA, thereafter resuscitated with ECPR (open reservoir, roller pump, membrane oxygenator, draining catheter in the right jugular vein, inflow catheter in the right femoral artery; custom made bypass system), mechanical ventilation and drugs (epinephrine, bicarbonate, heparin). After defibrillation and ROSC, rats survived for 14 days and were compared to 7 sham animals. The hearts were isolated and mounted onto an erythrocyte-perfused, isolated working heart (WH) system. Cardiac output, left ventricular systolic pressure (LVSP), coronary flow and pressure-volume (P-V) relationships (by increasing the afterload in 10 mmHg increments) were measured. Myocardium of all rats was evaluated pathohistological in hematoxylin-eosin staining. Results: ROSC was achieved in 18 animals after 6 min of CA, of which 10 survived 14 d and 7 were investigated in WH, in 8 min CA group 15 achieved ROSC of which 5 survived to 14 d and 2 were investigated in WH and compared to the hearts of 7 sham animals. At defined afterload (60 mm Hg; baseline) there was no difference in cardiac hemodynamics between sham and 6 min CA group. In contrast, 8 min CA rats showed a tendency towards decrease in cardiac output and LVSP compared to sham animals. Notably, both CA groups showed impaired P-V loop relationship and subsequently less tolerance to hemodynamic stress. Histologically all 8 min CA rats showed multiple foci of myocardial scarring. Conclusions: CA led to impaired left ventricular hemodynamics in 8 min CA rats resuscitated with ECPR. In addition, hearts were more vulnerable to hemodynamic stress after successful resuscitation. For investigating the effects of future therapy approaches during and after resuscitation from CA on the heart function, isolated WH might be a promising approach in resuscitation research.

Download Full-text

Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

Expert Review of Medical Devices ◽

10.1080/17434440.2021.1886076 ◽

2021 ◽

pp. 1-10

Author(s):

Christopher Gaisendrees ◽

Matias Vollmer ◽

Sebastian G Walter ◽

Ilija Djordjevic ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

Download Full-text

Cardiac arrest complicating cardiogenic shock: from pathophysiological insights to Impella-assisted cardiopulmonary resuscitation in a pheochromocytoma-induced Takotsubo cardiomyopathy—a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab092 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Filippo Zilio ◽

Simone Muraglia ◽

Roberto Bonmassari

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Left Ventricle ◽

Cardiogenic Shock ◽

Takotsubo Cardiomyopathy ◽

Perfusion Pressure ◽

Coronary Perfusion Pressure ◽

Left Ventricular ◽

Coronary Perfusion ◽

Refractory Cardiac Arrest

Abstract Background A ‘catecholamine storm’ in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella®) could help in achieving the return of spontaneous circulation (ROSC). Case summary A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella® placement. Discussion In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.

Download Full-text

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Journal of Intensive Care Medicine ◽

10.1177/08850666211018982 ◽

2021 ◽

pp. 088506662110189

Author(s):

Merry Huang ◽

Aaron Shoskes ◽

Migdady Ibrahim ◽

Moein Amin ◽

Leen Hasan ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Targeted Temperature Management ◽

Temperature Management ◽

Survival Outcomes ◽

Pool Data ◽

Good Neurological Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Over Time

Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

Download Full-text