Abstract 17412: Current Experience and Limitations of Extracorporeal Cardiopulmonary Resuscitation for Cardiac Arrest: A Single-Center Retrospective Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Aditi Singhvi ◽  
Nirav Patel ◽  
Jason A Gluck
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Selection Criteria ◽  
Spontaneous Circulation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Outcomes ◽  
Time To Initiation ◽  
Central Access ◽  
Refractory Cardiac Arrest

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.

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

2017 ◽  
Vol 7 (5) ◽  
pp. 432-441 ◽  
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.

Abstract 114: Effect of Body Position on Intracranial Pressure and Carotid Blood Flow During Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Yaël Levy ◽  
Rocio Fernandez ◽  
Fanny Lidouren ◽  
Matthias Kohlhauer ◽  
Lionel Lamhaut ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Intracranial Pressure ◽  
Cardiopulmonary Resuscitation ◽  
Body Position ◽  
Spontaneous Circulation ◽  
Systemic Hemodynamics ◽  
Body Tilt ◽  
Whole Body ◽  
Extracorporeal Cardiopulmonary Resuscitation

Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) using extracorporeal membrane oxygenation (ECMO) is widely proposed for the treatment of refractory cardiac arrest. Hypothesis: Since cerebral autoregulation is altered in such conditions, body position may modify hemodynamics during ECPR. Our goal was to determine whether a whole body tilt-up challenge (TUC) could lower intracranial pressure (ICP) as previously shown with conventional CPR, without deteriorating cerebral blood flow (CBF). Methods: Pigs were anesthetized and instrumented for the continuous evaluation of CBF, ICP and systemic hemodynamics. After 15 min of untreated ventricular fibrillation they were treated with 30 min of E-CPR followed by sequential defibrillation shocks until resumption of spontaneous circulation (ROSC). ECMO was continued after ROSC to target a mean arterial pressure (MAP) >60 mmHg. Animals were maintained in the flat position (FP) throughout protocol, except during a 2 min TUC of the whole body (+30°) at baseline, during E-CPR and after-ROSC. Results: Four animals received the entire procedure and ROSC was obtained in 3/4. After cardiac arrest, E-CPR was delivered at 29±2 ml/kg/min to maintain a MAP of 57±8 mmHg in the FP. CBF was 28% of baseline and ICP remain stable (12±1 vs 13±1 mmHg during ECPR vs baseline, respectively). Under baseline pre-arrest conditions TUC resulted in a significant decrease in ICP (-63±7%) and CBF (-21±3%) versus the FP, with no significant effect on systemic hemodynamics. During E-CPR and after ROSC, TUC markedly reduced ICP but CBF remained unchanged vs the FP (Figure). Conclusion: During E-CPR whole body TUC reduced ICP without lowering CBF compared with E-CPR flat. Additional investigations with prolonged TUC and selective head and thorax elevation during E-CPR are warranted.

scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

scholarly journals Just the Facts: Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 760-763
Author(s):  
Shannon M. Fernando ◽  
Brian Grunau ◽  
Daniel Brodie
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Tertiary Care Centre ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
St Segment Elevation ◽  
St Segment ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

A 58-year-old man is brought by the ambulance to the emergency department (ED) of a tertiary care centre following an out-of-hospital cardiac arrest. Paramedics were called by the patient's wife after he had collapsed. She immediately initiated cardiopulmonary resuscitation (CPR). Prior to his collapse, he had been complaining of chest pain. His initial rhythm in the field was ventricular fibrillation, and he received defibrillation. An automated CPR device was applied prior to transport. En route, return of spontaneous circulation is achieved. An electrocardiogram shows ST-segment elevation in the anterior leads. Just prior to arrival, the patient suffers recurrent cardiac arrest with two further rounds of unsuccessful defibrillation in the ED. At this point, a decision is made to proceed with extracorporeal cardiopulmonary resuscitation (ECPR), prior to transport for cardiac catheterization.

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