Abstract 364: Association Between Cardiac Arrest to Start of Extracorporeal Cardiopulmonary Resuscitation and Outcome in Patients With Out-of-Hospital Cardiac Arrest Due to Acute Coronary Syndrome

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shoji Kawakami ◽  
Yoshio Tahara ◽  
Teruo Noguchi ◽  
Shujiro Inoue ◽  
Satoshi Yasuda
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cutoff Point ◽  
Receiver Operating Curve ◽  
Target Temperature Management ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Coronary Syndrome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background: The proper timing of introducing extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has yet to be well-established. Hypothesis: The interval of start of ECPR from cardiac arrest is one of predictors of short-term survival in these particularly ill patients. Methods: Between June 2014 and December 2015, we enrolled a total of 13,491 Japanese OHCA patients who were transported to hospitals in a multicenter, prospective fashion (JAAM-OHCA registry). Following exclusion criteria, 72 patients with OHCA due to ACS who were introduced ECPR until return of spontaneous circulation and underwent emergent PCI and target temperature management were eligible for this study (median 59 years-old; 95% male). We investigated the relationship between the interval of start of ECPR or successfully coronary revascularization from cardiac arrest (collapse-to-ECPR or collapse-to-PCI interval) and the survival at 30 days. Results: Patients with survival at 30 days were 50% (n=36). Age, gender, the prevalence of patients with bystander CPR or ST-elevation and collapse-to-PCI interval were comparable between patients with/without survival. The survival patients had the higher prevalence of initial shockable rhythm and the shorter collapse-to-ECPR interval than those without survival (84 vs 57%, p=0.018; 50 vs 57 min, p=0.045). Receiver operating curve analysis indicated collapse-to-ECPR interval cutoff point of 50 min (area under the curve 0.66, sensitivity 54%, specificity 75%) and collapse-to-PCI interval cutoff point of 135 min (0.65, 64%, and 67%, respectively) for predicting survival at 30 days. Multivariate logistic regression analysis revealed initial shockable rhythm and collapse-to-ECPR interval as the independent predictors of survival (OR 5.71, p=0.015; OR 1.05, p=0.025, respectively). Conclusion: Collapse-to-ECPR interval is a significantly associated with 30 days survival in patients with OHCA due to ACS, while collapse-to-PCI interval is not independent predictor of survival in this study. These findings indicate that time management for start of ECPR from cardiac arrest can be essential for improving OHCA patients’ survival.

Abstract 263: The Relationship Between Time to Extracorporeal Cardiopulmonary Resuscitation and Coronary Reperfusion and Short-term Outcome in Out-of-hospital Cardiac Arrest Patients Due to Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Shoji Kawakami ◽  
Yoshio Tahara ◽  
Teruo Noguchi ◽  
Shujiro Inoue ◽  
Satoshi Yasuda
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Multivariate Logistic Regression Analysis ◽  
Cutoff Point ◽  
Receiver Operating Curve ◽  
Coronary Reperfusion ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Background: In out-of-hospital cardiac arrest (OHCA) patients due to acute coronary syndrome (ACS), the association between time to extracorporeal cardiopulmonary resuscitation (ECPR) or coronary reperfusion and clinical outcome has yet to be well-known. Methods: Between June 2014 and 2017, we enrolled a total of 34,754 OHCA patients in multicenter, prospective fashion (JAAM-OHCA registry). Following exclusion criteria, 254 OHCA patients with underwent ECPR and emergent PCI were eligible for this study (59±12 years-old; 92% male). We investigated the association between call-to-ECPR or call-to-reperfusion and the survival at 30 days. Results: The survival patients were 85 (33%). Figure shows the numbers of patients according to call-to-ECPR interval. The call-to-ECPR interval and call-to-reperfusion interval in survival patients were significantly shorter than those in non-survival patients (51±16 vs 61±16 min, p<0.01; 123±50 vs 157±133 min, p=0.03, respectively). Receiver operating curve analysis indicated call-to-ECPR interval cutoff point of 46 min (area under the curve 0.70, sensitivity 48%, specificity 84%) and call-to-reperfusion interval cutoff point of 92 min (0.61, 37% and 81%, respectively) for predicting survival at 30 days. Multivariate logistic regression analysis revealed call-to-ECPR interval and call-to-reperfusion as the independent predictors of survival (OR 0.96, 95%CI 0.94-0.98, p<0.01; OR 1.00, 95%CI 0.99-1.00, p=0.03, respectively). Conclusion: The call-to-ECPR interval and call-to-reperfusion interval are independent predictors of survival at 30 days in OHCA patients due to ACS.

scholarly journals Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

2021 ◽  
Vol 29 (3) ◽  
pp. 311-319
Author(s):  
Mustafa Emre Gürcü ◽  
Şeyhmus Külahçıoğlu ◽  
Pınar Karaca Baysal ◽  
Serdar Fidan ◽  
Cem Doğan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular Ejection ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
Hospital Cardiac Arrest

Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients. Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded. Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%. Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

2020 ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

Abstract 206: Neurological Outcomes and the Time From Collapse to the Initiation of Extracorporeal Membrance Oxygenation in Patients With Out-Of-Hospital and In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Tomoko Nakayama ◽  
Yudai Tamura ◽  
Megumi Yamamuro ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Receiver Operating Curve ◽  
Optimal Timing ◽  
Neurological Outcomes ◽  
Coronary Syndrome ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Outcome Group ◽  
Hospital Cardiac Arrest ◽  
Refractory Cardiac Arrest

Background: Encouraging results of extracorporeal cardiopulmonary resuscitation (E-CPR) for patients with refractory cardiac arrest have been shown. However, an optimal timing to switch from conventional CPR to E-CPR are not well established. To determine the optimal timing when E-CPR should be performed, we investigated the relationship between the time from collapse to the initiation of extracorporeal membrane oxygenation (Collapse-to-ECMO time ) and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) treated with E-CPR. Methods: A total of 80 consecutive patients (age 64±16 years, male ratio 76%, shockable rhythm 48%, and OHCA 51%) received E-CPR between January 2012 and May 2019. The primary endpoint was survival with good neurological outcomes at hospital discharge (a cerebral performance category of 1 or 2). Results: Of the 80 patients included, 8 had good neurological outcomes. The rate of male was significantly higher in the good outcome group compared with the non-good outcome group. There was no significant difference in the age and the rates of initial shockable rhythm and acute coronary syndrome between the two groups. IHCA had the better outcomes compared with OHCA, but the difference does not reach significance [15.4% (6 of 39) vs. 4.9% (2 of 41); P=0.1]. The median Collapse-to-ECMO time was significantly shorter in the good outcome group compared with the non-good outcome group (38.5 min, interquartile range [IQR], 19.3-54.5 vs. 58.5 min, IQR, 35.3-76.0: p = 0.04). The area under the receiver operating curve of the Collapse-to-ECMO time for predicting a good neurological outcome was 0.72, and the optimal cutoff time was 60 min. Stepwise multivariate logistic regression analysis including data on age, sex, shockable rhythm, OHCA, and the Collapse-to-ECMO time under 60 min revealed that a male sex (P=0.03), shockable rhythm (P=0.03) and the Collapse-to-ECMO time under 60 min (P<0.001) were significantly associated with the good outcome. Conclusions: The Collapse-to-ECMO time was independently associated with good neurological outcomes. In patients with refractory cardiac arrest, it may be considered to initiate E-CPR within 60 min from collapse regardless of OHCA or IHCA.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

2020 ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome.Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology.Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

scholarly journals Shockable Rhythm at Hospital Arrival as the Predictor of Favourable Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest (OHCA) Receiving Extracorporeal Cardiopulmonary Resuscitation (ECPR)

2021 ◽  
Author(s):  
Pei-I Su ◽  
Min-Shan Tsai ◽  
Wei-Ting Chen ◽  
Chih-Hung Wang ◽  
Wei-Tien Chang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Multiple Logistic Regression ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Introduction: For patients with out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation under advanced life support, extracorporeal cardiopulmonary resuscitation (ECPR) is the only lifesaving option. This study aimed to analyse the predictors of favourable neurological outcomes (FO, cerebral performance category 1-2) at hospital discharge among patients with OHCA following ECPR.Methods: In this single-centre retrospective study, 126 patients with OHCA who received ECPR between January 2012 and December 2019 were enrolled. The primary outcome was the FO at hospital discharge. The predictors of FO were assessed using multiple logistic regression analysis. Patients with an initial shockable rhythm were further analysed according to the cardiac rhythm at the time of hospital arrival. Results: Among the patients who received ECPR, the FO at hospital discharge was 21%. Certain resuscitation variables were associated with FO including witnessed collapse (P=0.014), bystander CPR (P=0.05), shorter no-flow time (P=0.008), and a shockable rhythm at hospital arrival (P=0.009). Multiple logistic regression showed that a shockable rhythm at hospital arrival was the only independent predictor of FO at discharge (odds ratio, 3.012; 95% confidence interval, 1.06-8.53; P=0.038). Among patients with an initial shockable rhythm, the group with a shockable rhythm at hospital arrival had a FO of 30%, which was significantly higher than the 11% in the non-shockable rhythm group (P=0.043).Conclusions: In patients with OHCA who received ECPR, a shockable rhythm at the time of hospital arrival was associated with favourable neurological outcomes at discharge. The ECPR selection criteria could consider the rhythm at hospital arrival.

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