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.

scholarly journals Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3583
Author(s):  
Styliani Syntila ◽  
Georgios Chatzis ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Christian Waechter ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Survival Rates ◽  
Limb Ischemia ◽  
Spontaneous Circulation ◽  
Access Site ◽  
Baseline Characteristics ◽  
Hospital Cardiac Arrest

Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.

scholarly journals O10 Myocardial tolerance to exsanguination and retrieval using whole blood-selective aortic arch perfusion

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
M J Madurska ◽  
N N Elansary ◽  
N Pate ◽  
J Edwards ◽  
M J Richmond ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Aortic Arch ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Treatment Modalities ◽  
Swine Model ◽  
Male Adult ◽  
Resuscitation Fluid ◽  
Baseline Characteristics

Abstract Introduction Exsanguination cardiac arrest is the leading preventable cause of death in trauma. Treatment modalities are limited, and prognosis remains dismal. Selective aortic arch perfusion (SAAP) is an emerging endovascular resuscitation technique consisting of aortic occlusion and perfusion of coronary and cerebral circulation with oxygenated resuscitation fluid. Translational research has demonstrated promising outcomes; however, little is known about the duration of cardiac arrest beyond which the myocardium cannot be resuscitated. The aims of this study are to assess the myocardial tolerance to exsanguination cardiac arrest before successful return of spontaneous circulation (ROSC) following resuscitation with SAAP, and 1-hour survival. Method 23 male adult swine were anaesthetised and instrumented. Controlled hemorrhage was performed until cardiac arrest defined by MAP &lt;20 mmHg. Animals were randomized into 3 groups: 5, 10 and 15 minutes of cardiac arrest before resuscitation with SAAP. Following ROSC animals were observed for 60 minutes. Result Baseline characteristics were similar between groups (P &gt; 0.05). ROSC was 100% (8/8) in the 5 min group, 75% (6/8) and 43% (3/7) in 10- and 15-min groups respectively (P = 0.042). 60 min survival was 75%, 50% and 14% in 5-, 10- and 15-min groups respectively (P = 0.015). 1-hour survivors in the 5 min group required less noradrenaline 23.6 (±7.4) compared to other animals 40.9 (±25.8), (P = 0.008). Conclusion Selective aortic arch perfusion is an effective resuscitative tool in eliciting ROSC in a swine model of exsanguination cardiac arrest lasting &gt;5 min. Sustainable resuscitability using SAAP declines after 10 min of exsanguination cardiac arrest. Take-home Message SAAP is an emerging resuscitation technique with promising outcomes in exsanguination cardiac arrest and may be a segway to Extracorporeal life support. The time limit for resuscitability of the myocardium lies somewhere between 10 and 15 min after the start of exsanguination cardiac arrest.

scholarly journals Timing of inducing therapeutic hypothermia in patients successfully resuscitated after out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792095856
Author(s):  
Doo Youp Kim ◽  
Jin Sup Park ◽  
Sun Hak Lee ◽  
Jeong Cheon Choe ◽  
Jin Hee Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Therapeutic Hypothermia ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Therapeutic hypothermia can improve neurological status in cardiac arrest survivors. Objectives: We investigated the association between the timing of inducing therapeutic hypothermia and neurological outcomes in patients who experienced out-of-hospital cardiac arrest. Methods: We evaluated data from 116 patients who were comatose after return of spontaneous circulation and those who received therapeutic hypothermia between January 2013 and April 2017. The primary endpoint was good neurological outcomes during index hospitalization, defined as a cerebral performance category score of 1 or 2. Therapeutic hypothermia timing was defined as the duration from the return of spontaneous circulation to hypothermia initiation. We analyzed the effect of early hypothermia induction on neurological results. Results: In total, 112 patients were enrolled. The median duration to hypothermia initiation was 284 min (25th–75th percentile, 171–418 min). Eighty-two (69.5%) patients underwent hypothermia within 6 h, and 30 (25.4%) had good neurological outcomes. The rates of good neurological outcomes by hypothermia initiation time quartile (shortest to longest) were 28.3%, 34.5%, 14.8%, and 28.6% (p = 0.401). The good neurologic outcomes did not differ between hypothermia patients within 6 h or after (26.5% vs 26.7%, p = 0.986). Short low-flow time and bystander resuscitation were associated with good neurological outcomes (p = 0.044, confidence interval: 0.027–0.955), but the timing of hypothermia initiation was not (p = 0.602, confidence interval: 0.622–1.317). Conclusion: A shorter low-flow time was associated with good neurological outcomes in out-of-hospital cardiac arrest patients who experienced hypothermia. However, inducing hypothermia sooner, even within 6 h, did not improve the neurological outcomes. Thus, as current guidelines recommend, initiating hypothermia within 6 h of recovery of spontaneous circulation is reasonable.

Abstract 325: Characteristics and Outcomes of Hanging Induced Out-Of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Arnaud Gille ◽  
Richard Chocron ◽  
Anna Ozguler ◽  
Xavier JOUVEN ◽  
Alain Cariou ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Low Flow ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Younger Age ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Hanging-induced Out-of-Hospital cardiac arrest (OHCA) is poorly studied and a better understanding of these specific OHCA could be helpful to improve patients’ outcome. The main objective of our study was to describe characteristics and outcomes in patients who had OHCA from hanging injuries. Methods: From May 2011 to December 2017 we analyzed a prospectively collected Utstein database for all OHCA adults. All cases due to hanging were included. Utstein style variables were compared for 2 groups of patients: those with a Return of Spontaneous Circulation (ROSC) and those without (non-ROSC). Continuous data are described as means (extremes). Results: Among 25 055 OHCA, 500 patients were included. They were 49 (18-100) years old. Seventy-three (14.6%) hanging were witnessed and 58 (11.6%) benefited from a bystander cardiopulmonary resuscitation before Emergency Medical Service (EMS) arrival. No-flow duration was 29.1 (4-180) minutes. Advance life support was initiated by EMS in 299 (59.8%) cases. Low-flow duration was 23.8 (2-79) minutes. Nine patients (1.8%) had a shockable initial rhythm. We observed 83 (16.6%) ROSC. Four (0.8%) patients were discharged alive from hospital. They were all CPC 1. Table 1 compares characteristics with significant differences between ROSC and non-ROSC groups. Conclusion: As expected, younger age, short no-flow and low-flow durations and shockable rhythm on EMS arrival were significantly associated with ROSC. Overall prognosis is dramatically poor when OHCA is due to hanging (<1%), with a very low proportion of shockable rhythm, even if the rare survivors have an excellent CPC at discharge. Indeed, the best method to reduce the mortality rate of hanging is, with no contest, the prevention of suicidal act.

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

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

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