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.

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.

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.

scholarly journals Cardiac Arrest Prior to Initiation of Veno-Venous Extracorporeal Membrane Oxygenation Is Not Associated with Increased In-Hospital Mortality

ASAIO Journal ◽  
2020 ◽  
Vol 66 (6) ◽  
pp. e79-e81
Author(s):  
Kevin M. Jones ◽  
Laura DiChiacchio ◽  
Kristopher B. Deatrick ◽  
Katelyn Dolly ◽  
Jeffrey Rea ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Membrane Oxygenation

Venoarterial extracorporeal membrane oxygenation in adult patients: predictors of mortality

Perfusion ◽  
2009 ◽  
Vol 24 (4) ◽  
pp. 225-230 ◽  
Author(s):  
JingwenLi ◽  
Cun Long ◽  
Song Lou ◽  
Feilong Hei ◽  
Kun Yu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Adult Patients ◽  
Hospital Death ◽  
Predictive Values ◽  
Predictors Of Mortality ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Clinical Records

Background: Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. In this study, we reviewed our experience with extracorporeal membrane oxygenation support and tried to identify measurable values which might predict in-hospital mortality. Methods: From January 2004 through December 2008, 50 of 21,298 adult patients received venoarterial extracorporeal membrane oxygenation. We retrospectively analyzed clinical records of these 50 consecutive patients. Details of demographics, preoperative measurements, clinical characteristics at the time of extracorporeal membrane oxygenation implantation, extracorporeal membrane oxygenation-related complications and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A p-value ≤ 0.05 was accepted as significant. Results: Thirty-eight patients were weaned from extracorporeal membrane oxygenation and 33 patients survived to discharge. The overall survival rate was 66%. In a multiple logistic regression analysis, blood lactate level before initiation of extracorporeal membrane oxygenation was a risk factor associated with in-hospital mortality (OR 1.27 95% CI 1.042-1.542). To evaluate the utility of the lactate in predicting mortality, a conventional receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 12.6mmol/L, with an area under the curve of 0.752. The positive and negative predictive values were 73.3% and 83.9%, respectively. Conclusions: Extracorporeal membrane oxygenation is a justifiable alternative treatment for postoperative refractory cardiac and pulmonary dysfunction which could rescue more than sixty percent of otherwise fatal patients. Patients with pre-extracorporeal membrane oxygenation lactate levels above 12.6mmol/L are at higher risks for in-hospital death. Evidence-based therapy for this group of high risk patients is needed.

scholarly journals Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

CJEM ◽  
2015 ◽  
Vol 17 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Riyad B. Abu-Laban ◽  
David Migneault ◽  
Meghan R. Grant ◽  
Vinay Dhingra ◽  
Anthony Fung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Membrane Oxygenation ◽  
Cardiorespiratory Function ◽  
Neurologic Sequelae

AbstractExtracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid–left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient’s cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.

Characterization of Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest in the United States: Analysis of the Kids’ Inpatient Database

2013 ◽  
Vol 34 (6) ◽  
pp. 1422-1430 ◽  
Author(s):  
Adam W. Lowry ◽  
David L. S. Morales ◽  
Daniel E. Graves ◽  
Jarrod D. Knudson ◽  
Pirouz Shamszad ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Membrane Oxygenation ◽  
Inpatient Database

scholarly journals Predictors of mortality in patients with VA-extracorporeal membrane oxygenation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kang ◽  
H.S Lee ◽  
S.M Han ◽  
H.J Cho
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Baseline Characteristic ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
History Of ◽  
Va Ecmo

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is a lifesaving tool used in the treatment of cardiogenic shock, acute heart failure, or extracorporeal cardiopulmonary resuscitation (CPR). We report on a single center experience with ECMO and aim to identify the prognostic markers for in-hospital mortality and death at 72 hours after ECMO. Methods Between 2011 and 2019 we evaluated 131 patients, who received ECMO. Collected data was analyzed to identify baseline characteristic, outcomes including clinical variables predictive of poor outcome. Results The mean age was 62.5 years, 67.2% were male patients, with prior CPR in 61.8%. The annual number of VA-ECMO procedures steadily increased, whereas in-hospital mortality is decreasing. Within the total cohort, the indication for VA-ECMO was cardiac arrest in 19.1%, acute coronary syndrome in 41.2%, acute heart failure in 23.7%, and myocarditis in 10.7%. Overall in-hospital mortality was 58.8%. Multivariate logistic regression model revealed presence of malignancy, history of revascularization, duration of cardiac arrest, and low BMI as independent predictors for mortality in 72 hours after ECMO (table). On the other hand, predictors of in-hospital mortality were prior congestive heart failure, male, and history of malignancy. The C-statistic for discriminating mortality in 72 hours after ECMO with the duration of cardiac arrest was 0.67 (figure). Conclusions Although the use of ECMO as a last line in the treatment of critical patients measures constitutes an important improvement in their care; with 41.2% overall survival; patient selection and timing of ECMO initiation remains challenging. The importance of consideration for ECMO use earlier in course of illness rather than later. Funding Acknowledgement Type of funding source: None

scholarly journals Adverse prognostic factors for rescuing patients with acute myocardial infarction–induced cardiac arrest receiving percutaneous coronary intervention under extracorporeal membrane oxygenation

2021 ◽  
pp. 102490792199761
Author(s):  
Jianxi Ye
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Membrane Oxygenation ◽  
Percutaneous Coronary ◽  
Induced Cardiac Arrest

Background: Acute myocardial infarction–induced cardiac arrest has high mortality rate. Objective: To investigate the risk factors of extracorporeal membrane oxygenation combined with percutaneous coronary intervention in rescuing acute myocardial infarction–induced cardiac arrest. Methods: Forty-three eligible patients were assigned into death and survival groups. Their general clinical data, treatment outcomes, and various indicators 24, 48, and 72 h after extracorporeal membrane oxygenation implantation were compared. The factors affecting clinical outcomes were determined by multivariate logistic regression analysis. A nomogram prediction model was constructed and validated. Results: After removing extracorporeal membrane oxygenation device, 19 patients recovered and 24 died (mortality rate: 55.81%). The two groups had different conventional cardiopulmonary resuscitation duration, number of diseased vessels, distribution of culprit vessel, time from cardiac arrest to extracorporeal membrane oxygenation implantation, length of stay in critical care unit, and mean arterial pressure 24 and 48 h after extracorporeal membrane oxygenation implantation ( p < 0.05). Left anterior descending as the culprit vessel, number of diseased vessels, conventional cardiopulmonary resuscitation duration, time from cardiac arrest to extracorporeal membrane oxygenation implantation, and mean arterial pressure 48 h after extracorporeal membrane oxygenation resuscitation were independent risk factors for death. The predicted mortality rate was 72.6%, and the actual concordance index (C-index) was 0.869. Such indices after internal and external validations were 0.861 and 0.848, respectively, suggesting a good concordance. Conclusion: Left anterior descending as the culprit vessel, number of diseased vessels, conventional cardiopulmonary resuscitation duration, time from cardiac arrest to extracorporeal membrane oxygenation implantation, and mean arterial pressure 48 h after extracorporeal membrane oxygenation resuscitation are independent risk factors for patients with acute myocardial infarction–induced cardiac arrest undergoing extracorporeal membrane oxygenation combined with percutaneous coronary intervention.

SAVE score with lactate modification predicts in-hospital mortality in patients with ongoing cardiac arrest during VA-ECMO cannulation

2021 ◽  
pp. 039139882110218
Author(s):  
Lee Ann Santore ◽  
James W Schurr ◽  
Mohammad Noubani ◽  
Andrew Rabenstein ◽  
Kathleen Dhundale ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Significant Variable ◽  
Membrane Oxygenation ◽  
Va Ecmo

The survival after veno-arterial extracorporeal membrane oxygenation score and its lactate modification predict in-hospital mortality in patients based on pre-extracorporeal membrane oxygenation variables. Cardiac arrest history is a significant variable in these scores; however, patients with ongoing cardiac arrest during cannulation were excluded from these models. The goal of this study is to validate the survival after veno-arterial extracorporeal membrane oxygenation score with a lactate modification among patients with ongoing cardiac arrest. In our study, the survival after veno-arterial extracorporeal membrane oxygenation score predicted mortality in all patients, but did so with higher discrimination among ongoing cardiac arrest patients with a lactate modification.

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