Abstract 14505: Determinants of Stabilization for Out-of-Hospital Cardiac Arrest Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ruben Crespo ◽  
Marinos Kosmopoulos ◽  
Demitris Yannopolous ◽  
Jason Bartos
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Cardiac Rhythm ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
The United States ◽  
Membrane Oxygenation ◽  
Coronary Interventions ◽  
Hospital Cardiac Arrest

Introduction: Sudden cardiac arrest causes approximately 400,000 deaths in the United States per year. Extracorporeal membrane oxygenation (ECMO), in conjunction with coronary interventions, was shown to improve survival for patients with refractory shockable rhythms in the ARREST trial. However, it remains unclear which parts of the protocol are critical for hemodynamic stabilization in these patients. Therefore, this study aims to assess patient status through each step of the ARREST trial protocol. Methods: Retrospective assessment was performed in 185 adults with refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest transported for ECPR. Continuous variables were compared using parametric or non-parametric testing when normality was not met. Chi-square was used to compare categorical values and linear regression models to compare associations between survival and angiographic characteristics. Results: Distribution data showed 32% of patients achieved ROSC prior to extracorporeal membrane oxygenation or coronary intervention, though they had ongoing cardiogenic shock. ECMO provided hemodynamic stabilization with an organized cardiac rhythm in 31% of patients prior to coronary intervention. ECMO and coronary revascularization was required for hemodynamic stabilization and development of an organized cardiac rhythm in 30% of patients. The remaining 7% of patients failed to achieve ROSC despite ECMO, revascularization, and medical therapy. The angiographic profile from each of these groups was evaluated and showed that 63% of all patients had obstructive CAD including 48% of patients that arrived with ROSC and cardiogenic shock, 71% of patients that stabilized with ECMO alone, and 100% of patients that achieved ROSC after coronary interventions (p<0.01). Conclusions: Coronary revascularization is not required for stabilization of most patients. However, the impact of coronary artery disease on recovery potential is not known.

scholarly journals Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Cardiac Arrest in Adult Patients in the United States

2021 ◽  
Author(s):  
George Gill ◽  
Jignesh K. Patel ◽  
Diego Casali ◽  
Georgina Rowe ◽  
Hongdao Meng ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
The United States ◽  
Mortality Factors ◽  
Factors Associated ◽  
Predictors Of Mortality ◽  
Membrane Oxygenation ◽  
Nationally Representative

Background Factors associated with poor prognosis following receipt of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest remain unclear. We aimed to identify predictors of mortality in adults with cardiac arrest receiving ECMO in a nationally representative sample. Methods and Results The US Healthcare Cost and Utilization Project's National Inpatient Sample was used to identify 782 adults hospitalized with cardiac arrest who received ECMO between 2006 and 2014. The primary outcome of interest was all‐cause in‐hospital mortality. Factors associated with mortality were analyzed using multivariable logistic regression. The overall in‐hospital mortality rate was 60.4% (n=472). Patients who died were older and more often men, of non‐White race, and with lower household income than those surviving to discharge. In the risk‐adjusted analysis, independent predictors of mortality included older age, male sex, lower annual income, absence of ventricular arrhythmia, absence of percutaneous coronary intervention, and presence of therapeutic hypothermia. Conclusions Demographic and therapeutic factors are independently associated with mortality in patients with cardiac arrest receiving ECMO. Identification of which patients with cardiac arrest may receive the utmost benefit from ECMO may aid with decision‐making regarding its implementation. Larger‐scale studies are warranted to assess the appropriate candidates for ECMO in cardiac arrest.

EXTRACORPOREAL MEMBRANE OXYGENATION FACILITATES SURVIVAL IN REFRACTORY IN- HOSPITAL CARDIAC ARREST AND CARDIOGENIC SHOCK

2014 ◽  
Vol 30 (10) ◽  
pp. S242-S243
Author(s):  
J.M. Bednarczyk ◽  
R.A. Ducas ◽  
C.W. White ◽  
M. Golian ◽  
R. Nepomuceno ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Membrane Oxygenation ◽  
Hospital Cardiac Arrest

scholarly journals Cost-utility of venoarterial extracorporeal membrane oxygenation in cardiogenic shock and cardiac arrest

2020 ◽  
Vol 9 (4) ◽  
pp. 333-341
Author(s):  
Salla Jäämaa-Holmberg ◽  
Birgitta Salmela ◽  
Raili Suojaranta ◽  
Karl B Lemström ◽  
Jyri Lommi
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: The use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock keeps increasing, but its cost-utility is unknown. Methods: We studied retrospectively the cost-utility of venoarterial extracorporeal membrane oxygenation in a five-year cohort of consequent patients treated due to refractory cardiogenic shock or cardiac arrest in a transplant centre in 2013–2017. In our centre, venoarterial extracorporeal membrane oxygenation is considered for all cardiogenic shock patients potentially eligible for heart transplantation, and for selected postcardiotomy patients. We assessed the costs of the index hospitalization and of the one-year hospital costs, and the patients’ health-related quality of life (response rate 71.7%). Based on the data and the population-based life expectancies, we calculated the amount and the costs of quality-adjusted life years gained both without discount and with an annual discount of 3.5%. Results: The cohort included 102 patients (78 cardiogenic shock; 24 cardiac arrest) of whom 67 (65.7%) survived to discharge and 66 (64.7%) to one year. The effective costs per one hospital survivor were 242,303€. Median in-hospital costs of the index hospitalization per patient were 129,967€ (interquartile range 150,340€). Mean predicted number of quality-adjusted life years gained by the treatment was 20.9 (standard deviation 9.7) without discount, and the median cost per quality-adjusted life year was 7474€ (interquartile range 10,973€). With the annual discount of 3.5%, 13.0 (standard deviation 4.8) quality-adjusted life years were gained with the cost of 12,642€ per quality-adjusted life year (interquartile range 15,059€). Conclusions: We found the use of venoarterial extracorporeal membrane oxygenation in refractory cardiogenic shock and cardiac arrest justified from the cost-utility point of view in a transplant centre setting.

Three consecutive cases of fatal intraoperative intracardiac thrombosis associated with the initiation of venoarterial extracorporeal membrane oxygenation in the presence of aprotinin

Perfusion ◽  
2019 ◽  
Vol 34 (5) ◽  
pp. 417-421 ◽  
Author(s):  
Chris Oscier ◽  
Chinmay Patvardhan ◽  
Florian Falter ◽  
Will Tosh ◽  
John Dunning ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Bleeding Risk ◽  
The United States ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Intracardiac Thrombosis

Central venoarterial extracorporeal membrane oxygenation has been used since the 1970s to support patients with cardiogenic shock following cardiac surgery. Despite this, in-hospital mortality is still high, and although rare, thrombus within the cardiac chambers or within the extracorporeal membrane oxygenation circuit is often fatal. Aprotinin is an antifibrinolytic available in Europe and Canada, though not currently in the United States. Due to historical safety concerns, use of aprotinin is generally limited and is commonly reserved for patients with the highest bleeding risk. Given the limited availability of aprotinin over the last decade, it is not surprising to find a complete absence of literature describing the use of venoarterial extracorporeal membrane oxygenation in the presence of aprotinin. We present three consecutive cases of rapid fatal intraoperative intracardiac thrombosis associated with post-cardiotomy central venoarterial extracorporeal membrane oxygenation in patients receiving aprotinin.

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