Abstract 211: Enteral Feeding Shortly After Cardiac Arrest Treated With Veno-Arterial Extra Corporeal Membrane Oxygenation and Therapeutic Hypothermia is Safe and Feasible

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Alejandra Gutierrez ◽  
Claire Carlson ◽  
Demetris Yannopoulos ◽  
Jason A Bartos
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Enteral Feeding ◽  
Adverse Outcomes ◽  
University Of Minnesota ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Early Enteral Feeding ◽  
Neurologic Outcomes ◽  
Va Ecmo

Introduction: Literature regarding the timing and safety of enteral feeding after cardiac arrest treated with therapeutic hypothermia and veno-arterial extra corporeal membrane oxygenation (VA-ECMO) is lacking. Aim: To describe the safety and feasibility of early enteral feeding in adult patients presenting with refractory out-of-hospital cardiac arrest treated with VA ECMO and therapeutic hypothermia. Methods: We performed a retrospective analysis of the enteral feeding patterns for patients admitted through the University of Minnesota ECPR program for refractory ventricular tachycardia or fibrillation (VT/VF). Outcomes were compared in patients with early enteral feeding initiation (within 2 days of admission) versus those with delayed enteral feeding (>2 days after admission). Results: The study included 108 consecutive patients (age 56.3+/-12.2 years, 78% male) admitted to the CICU between December 2015 and February 2019. Average CPR duration was 62.8+/-15.3min. Enteral feeding was initiated in 68(62.9%) of the sample. Enteral feeding was not started in patients expected to die within 48 hours of ICU admission. All patients underwent therapeutic hypothermia and 97.2% received neuromuscular blockade. Time to enteral feeding initiation ranged from 1 to 11 days post admission. Patients who had enteral feeding started within the first two days (43%) had similar rates of feeding interruption, (with 40% of cases in the setting of a surgical procedure or family request), gut ischemia, ileus and ventilator associated pneumonia (Table 1). Mortality and neurologic outcomes were not affected by timing of enteral feeding initiation. Conclusion: Initiation of enteral feeding within the first two days of presentation was not associated with adverse outcomes in patients with refractory cardiac arrest treated with prolonged CPR, VA ECMO, and therapeutic hypothermia.

Peripheral cannulation for extracorporeal membrane oxygenation yields superior neurologic outcomes in adult patients who experienced cardiac arrest following cardiac surgery

Perfusion ◽  
2021 ◽  
pp. 026765912110181
Author(s):  
Lauren E Levy ◽  
David J Kaczorowski ◽  
Chetan Pasrija ◽  
Gregory Boyajian ◽  
Michael Mazzeffi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Cause Of Death ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Neurologic Outcomes ◽  
Va Ecmo ◽  
Central Cannulation ◽  
Post Cardiac Surgery

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest has improved mortality in post-cardiac surgery patients; however, loss of neurologic function remains one of the main and devastating complications. We reviewed our experience with ECPR and investigated the effect of cannulation strategy on neurologic outcome in adult patients who experienced cardiac arrest following cardiac surgery that was managed with ECPR. Methods: Patients were categorized by central versus percutaneous peripheral VA-extracorporeal membrane oxygenation (ECMO) cannulation strategy. We reviewed patient records and evaluated in-hospital mortality, cause of death, and neurologic status 72 hours after cannulation. Results: From January 2010 to September 2019, 44 patients underwent post-cardiac surgery ECPR for cardiac arrest. Twenty-six patients received central cannulation; 18 patients received peripheral cannulation. Mean post-operative day of the cardiac arrest was 3 and 9 days (p = 0.006), and mean time between initiation of CPR and ECMO was 40 ± 24 and 28 ± 22 minutes for central and peripheral cannulation, respectively. After 72 hours of VA-ECMO support, 30% of centrally cannulated patients versus 72% of peripherally cannulated patients attained cerebral performance status 1–2 (p = 0.01). Anoxic brain injury was the cause of death in 26.9% of centrally cannulated and 11.1% of peripherally cannulated patients. Survival to discharge was 31% and 39% for central and peripheral cannulation, respectively. Conclusions: Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.

Veno-Arterial Extracorporeal Membrane Oxygenation in the Adult: A Bridge to the State of the Art

2020 ◽  
Vol 16 ◽  
Author(s):  
Marco Gennari ◽  
Camilla L’Acqua ◽  
Mara Rubino ◽  
Marco Agrifoglio ◽  
Luca Salvi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Circulatory Arrest ◽  
Adult Population ◽  
Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Vital Functions ◽  
Negative Condition ◽  
Hospital Institution ◽  
Va Ecmo

Abstract:: Despite the technological improvements of the last 40 years conditions such as refractory cardiogenic shock and cardiac arrest still present a very high mortality rate in the real-world clinical practice. In this light we have performed a review of the techniques, indications, contraindications and results of the so-called Veno-Arterial Extracorporeal Circulatory Membrane Oxygenation (VA-ECMO) in the adult population to evaluate the current results of this temporary cardio-pulmonary support as salvage and/or bridge therapy in patient suffering from refractory cardiogenic shock or cardio-circulatory arrest. The results are encouraging, especially in the setting of refractory cardiogenic shock and in-hospital cardiac arrest. Among a selected population the prompt institution of a VA-ECMO may radically change the prognosis by sustaining vital functions while looking for the leading cause or waiting for the reversal of the temporary cardio-respiratory negative condition. The future directions aim to standardized and shared protocols, miniaturization of the machines and possibly the institution of specialized “ECMO teams” for in and out-of-hospital institution of the tool.

Evaluating the effectiveness of resuscitation with extracorporeal membrane oxygenation in a model of acute hypoxic cardiac arrest in pigs (experimental study)

2014 ◽  
Vol 5 (4) ◽  
pp. 20-26
Author(s):  
Gennadiy Grigoryevich Khubulava ◽  
Aleksey Borisovich Naumov ◽  
Sergey Pavlovich Marchenko ◽  
Vitaliy Vladimirovich Suvorov ◽  
Igor Igorevich Averkin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Circulatory Support ◽  
Cardiac Massage ◽  
Membrane Oxygenation ◽  
Neurologic Outcomes ◽  
Intergroup Comparison ◽  
Life Threatening ◽  
Switching Method

Cardiopulmonary resuscitation (CPR) with closed-chest cardiac massage was developed to maintain circulation and ventilation until life-threatening problems could be corrected or reversed. Studies on the effect of CPR have shown that about 80-95 % cases of resuscitation are fatal or severe neurological consequences and survival to discharge after CPR ranged from 6 to 22 % [2, 4, 8, 11]. Furthermore, the chances of survival decline rapidly if the resuscitation period more than 10 minute. At the same time, we know that successful neurologic outcomes are inversely associated with the time of brain hypoperfusion. Because of the low survival rate after prolonged CPR, more aggressive methods have been suggested to increase success. With the advancement of techniques, extracorporeal mechanical support has been applied in conjunction with CPR, with variable results [5, 12]. To assess the efficacy of resuscitation with extracorporeal membrane oxygenation was modeled the acute hypoxic cardiac arrest in pigs. Results of the study in the two groups demonstrate efficient switching method supporting circulatory support (ECMO) in the minutes of CPR. In the provision of an extended set of measures of cardiopulmonary resuscitation in the modeling of hypoxic cardiac arrest in animals in the group with ECMO received great survival to the end of the experiment, less expressed manifestations of acute heart failure. Intergroup comparison given the prerequisites for the development of protocols with the use of ECMO CPR, which would reduce the number of complications and death in patients undergoing cardiac surgery.

Pyrexia and neurologic outcomes after therapeutic hypothermia for cardiac arrest

Resuscitation ◽  
2013 ◽  
Vol 84 (8) ◽  
pp. 1056-1061 ◽  
Author(s):  
Marion Leary ◽  
Anne V. Grossestreuer ◽  
Stephen Iannacone ◽  
Mariana Gonzalez ◽  
Frances S. Shofer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurologic Outcomes

Continuous electroencephalogram patterns are suggestive of eventual neurologic outcomes in post–cardiac arrest patients treated with therapeutic hypothermia

2015 ◽  
Vol 30 (1) ◽  
pp. 121-125 ◽  
Author(s):  
Dermot Maher ◽  
Huy Tran ◽  
Miriam Nuno ◽  
Dawn Eliashiv ◽  
Taizoon Yusufali ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurologic Outcomes

scholarly journals Neurological Prognostication of Cardiac Arrest in an Era of Extracorporeal Membrane Oxygenation

2016 ◽  
Vol 7 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Supreet K. Sahai ◽  
Tamara Majic ◽  
Jignesh Patel ◽  
Michael Nurok ◽  
Asma M. Moheet ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Therapeutic Hypothermia ◽  
Practice Guidelines ◽  
Poor Prognosis ◽  
Prognostic Markers ◽  
Neuron Specific Enolase ◽  
Membrane Oxygenation ◽  
Straightforward Application ◽  
Neurological Prognosis

A neuron-specific enolase level greater than 33 ng/mL at days 1 to 3 or status myoclonus within 1 day are traditional indicators of poor neurological prognosis in survivors of cardiac arrest. We report the case of a 70-year-old man who received extracorporeal membrane oxygenation following cardiac arrest. Despite having both an elevated neuron-specific enolase concentration of 68 ng/mL and status myoclonus, he made an excellent neurological recovery. The value of traditional markers of poor prognosis such as elevated neuron-specific enolase or status myoclonus has not been systematically validated in patients treated with extracorporeal membrane oxygenation or therapeutic hypothermia. Straightforward application of practice guidelines in these cases may result in tragic outcomes. This case underscores the need for reliable prognostic markers that account for recent advances in cardiopulmonary and neurological therapies.

AP099 Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac support after traumatic cardiac arrest (TCA)

Resuscitation ◽  
2011 ◽  
Vol 82 ◽  
pp. S32
Author(s):  
Vasilios Grosomanidis ◽  
Eleni Argyriadou ◽  
Barbara Fyntanidou ◽  
Omiros Halvatsoulis ◽  
Eleni Geka ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Traumatic Cardiac Arrest ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo
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