Management of accidental hypothermia: an established extracorporeal membrane oxygenation centre experience

Perfusion ◽  
2019 ◽  
Vol 34 (1_suppl) ◽  
pp. 74-81 ◽  
Author(s):  
Martin Balik ◽  
Michal Porizka ◽  
Vojtech Matousek ◽  
Petr Brestovansky ◽  
Eva Svobodova ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Gas Flow ◽  
Alcohol Intoxication ◽  
Outcome Data ◽  
Accidental Hypothermia ◽  
Prognostic Indicators ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
Refractory Cardiac Arrest

Introduction: Data on management of severe accidental hypothermia published from an established high-volume extracorporeal membrane oxygenation centre are scarce. Methods: A total of 28 patients with intravesical temperature lower than 28°C on admission were either treated with veno-arterial extracorporeal membrane oxygenation or rewarmed conservatively. Results: A total of 10 patients rewarmed on veno-arterial extracorporeal membrane oxygenation (age: 37 ± 12.6 years) and 18 conservatively (age: 55.2 ± 11.2 years) were collected over a course of 5 years. The dominant cause was alcohol intoxication with exposure to cold (39%), 12 patients were resuscitated prior to admission. The admission temperature in the extracorporeal membrane oxygenation group (23.8 ± 2.6°C) was lower than in the non–extracorporeal membrane oxygenation group (26.0 ± 1.5°C, p = 0.01). The peripheral percutaneous veno-arterial extracorporeal membrane oxygenation was always cannulated in malignant arrhythmias causing refractory cardiac arrest. The typical extracorporeal membrane oxygenation blood flow was 3-4 L/minute and sweep gas flow 2 L/minute, the median extracorporeal membrane oxygenation duration was 48.3 (28.1-86.7) hours. The median rates of rewarming did not differ (0.41 (0.35-0.7)°C/hour in extracorporeal membrane oxygenation and 0.77 (0.54-0.98)°C/hour in non–extracorporeal membrane oxygenation, p = 0.46) as well as the admission arterial lactate, pH and potassium. Their development was not different between the groups except for higher pH between the third and ninth hour of rewarming in the extracorporeal membrane oxygenation group. The hospital mortality was 10% in the extracorporeal membrane oxygenation group and 11.1% in the non–extracorporeal membrane oxygenation group with the median last Glasgow Coma Scale 15 and Cerebral Performance Score 1. Conclusion: Veno-arterial extracorporeal membrane oxygenation for severe hypothermia shows promising outcome data collected in an extracorporeal membrane oxygenation/extracorporeal cardiopulmonary resuscitation centre located in a European urban area. Except for presence of refractory cardiac arrest, the established hypothermia-related prognostic indicators did not differ between patients in need for extracorporeal membrane oxygenation and those rewarmed without extracorporeal membrane oxygenation.

Prospective observational study of mechanical cardiopulmonary resuscitation, extracorporeal membrane oxygenation and early reperfusion for refractory cardiac arrest in Sydney: the 2CHEER study

2020 ◽  
Vol 22 (1) ◽  
pp. 26-34
Author(s):  
Mark Dennis ◽  
◽  
Hergen Buscher ◽  
David Gattas ◽  
Brian Burns ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Survival Rates ◽  
Ecmo Support ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Early Reperfusion ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
Refractory Cardiac Arrest

BACKGROUND: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39–65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38–73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24–108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.

Aluminium phosphide poisoning resulting in cardiac arrest, successful treatment with Extracorporeal Cardiopulmonary resuscitation (ECPR): a case report

Perfusion ◽  
2018 ◽  
Vol 33 (7) ◽  
pp. 597-598 ◽  
Author(s):  
Juan Lehoux ◽  
Zachary Hena ◽  
Megan McCabe ◽  
Giles Peek
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Successful Treatment ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
Aluminium Phosphide

Aluminium phosphide (AP) is a pesticide used against rodents and insects. Exposure of AP to water releases phosphine gas. Phosphine is a highly toxic mitochondrial poison to which there is no known antidote. We report a case of a 3-year-old female with accidental home exposure to AP, which resulted in cardiac arrest, who was successfully supported with extracorporeal membrane oxygenation (ECMO).

Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study

2020 ◽  
Vol 46 (5) ◽  
pp. 973-982 ◽  
Author(s):  
Dirk Lunz ◽  
Lorenzo Calabrò ◽  
Mirko Belliato ◽  
Enrico Contri ◽  
Lars Mikael Broman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Multicenter Study ◽  
Membrane Oxygenation ◽  
Retrospective Multicenter Study ◽  
Refractory Cardiac Arrest

An urgent open surgical approach for left ventricle venting during peripheral veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: case report

Perfusion ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 82-85 ◽  
Author(s):  
Christophe Beyls ◽  
Pierre Huette ◽  
Mathieu Guilbart ◽  
Alphonse Nzonzuma ◽  
Osama Abou Arab ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Transesophageal Echocardiography ◽  
Surgical Approach ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Membrane Oxygenation ◽  
Refractory Cardiac Arrest

The objective of the study is to describe an emergency procedure for left ventricle venting during veno-arterial extracorporeal life support for refractory cardiac arrest. Veno-arterial extracorporeal membrane oxygenation is widely used in refractory cardiac arrest but is characterized by an increase in left ventricle afterload, which may impair cardiac contractility improvement. Different left ventricle venting techniques are available. We report the use of a surgical approach with sternotomy for left ventricle venting in a 21-year-old patient who was placed under veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest with severe pulmonary edema, respiratory failure, and left ventricle stasis. A 21-year-old woman was admitted for laparoscopic sleeve gastrectomy. In the recovery room, she developed a refractory circulatory shock. Transthoracic echocardiography revealed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (left ventricle ejection fraction at 20%). Coronary angiogram was normal. On day 2, she underwent laparotomy for sepsis and she presented cardiac arrest secondary to ventricular tachycardia. We proceeded to peripheral veno-arterial extracorporeal membrane oxygenation as the cardiac arrest was refractory. A miniaturized veno-arterial extracorporeal membrane oxygenation system was implanted into the right femoral vessels onsite .The low flow duration was 40 minutes. Veno-arterial extracorporeal membrane oxygenation blood flow was set to 3 L min−1, resulting in a closed aortic valve and a massive pulmonary edema. Transesophageal echocardiography showed left ventricular ejection fraction at 5% without aortic valve opening. We first implanted an intra-aortic balloon pump without clinical improvement. Transesophageal echocardiography revealed massive thrombus formation into the aortic root. We decided to perform an open surgical approach for left ventricle unload using a transmitral cannula (22 Fr) via the right superior pulmonary vein connected to the inflow tube of the veno-arterial extracorporeal membrane oxygenation with Y connection. Transesophageal echocardiography showed a full opening of aortic valve and elimination of valve aortic thrombus. Chest radiography showed a significant decrease of pulmonary congestion. We were able to withdraw extracorporeal life support organization on day 10 and discharged on day 54. Clinical explorations reveal a fulminant rocuronium-related hypersensitivity myocarditis. This salvage surgical technique using a modified central veno-arterial extracorporeal membrane oxygenation cannulation technique has efficiently decreased blood stasis and permitted rapid recovery.

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

2015 ◽  
Vol 35 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Jennie Ryan
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Survival Rates ◽  
Underlying Disease ◽  
The Body ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
The Impact

Extracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With venoarterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient’s caregivers. Offering support and guidance to the patient’s family as well as the patient is essential.

Comparing in-patient extracorporeal cardiopulmonary resuscitation to standard cardiac treatment group of extracorporeal membrane oxygenation patients: 8 years of experience at a single institution

Perfusion ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Spencer Liem ◽  
Nicholas C Cavarocchi ◽  
Hitoshi Hirose
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Neurological Complications ◽  
Neurological Injury ◽  
Years Of Experience ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Survival ◽  
Membrane Oxygenation

Introduction: Post-cardiac arrest survivals remain low despite the effort of cardiopulmonary resuscitation. Utilization of extracorporeal membrane oxygenation during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation) can provide immediate cardiovascular support and potentially improve outcomes of patients with cardiac arrest requiring cardiopulmonary resuscitation. There is renewed interest in the use of extracorporeal cardiopulmonary resuscitation due to improved outcomes over the years. Methods: Extracorporeal membrane oxygenation data between 2010 and 2018 were reviewed. Patients with extracorporeal membrane oxygenation placed under cardiopulmonary resuscitation were identified, and demographics, extracorporeal membrane oxygenation survival, survival to discharge, and neurological recovery were retrospectively analyzed with institutional review board approval. Results: Among 230 cases of extracorporeal membrane oxygenation, 34 (21 males and 13 females, age of 49 ± 13 years) underwent extracorporeal cardiopulmonary resuscitation. The mean duration of extracorporeal membrane oxygenation support after extracorporeal cardiopulmonary resuscitation was 8.3 ± 7.9 days. Extracorporeal membrane oxygenation mortality among extracorporeal cardiopulmonary resuscitation patients was 32% (11/34) and hospital survival was 38% (13/34), which are similar to standard cardiac extracorporeal membrane oxygenation (extracorporeal membrane oxygenation survival 62% and hospital survival 39% in cardiac extracorporeal membrane oxygenation). Among the extracorporeal membrane oxygenation death after extracorporeal cardiopulmonary resuscitation, the majority was due to neurological injury (73%, 8/11); 8/34 extracorporeal membrane oxygenation survival rate and 30-day survival rate were 63% and 25% in early half of study (2010-2014) and have improved to 70% and 60% in late half of study (2014-2018). Conclusion: Over years of experience with extracorporeal membrane oxygenation, the outcome of the extracorporeal cardiopulmonary resuscitation has been improving and appears to exceed those of traditional methods, despite limited sample size. Neurological complications still need to be addressed in order for survival and outcomes to improve.

Abstract 13076: Refractory Out-of-Hospital Cardiac Arrest in Patients With Pulmonary Embolism and Use of Extracorporeal Membrane Oxygenation: Prague OHCA Study Subanalysis

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jan Pudil ◽  
Jana Smalcova ◽  
Ondrej Smid ◽  
Daniel Rob ◽  
Michaela Hronova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Primary Outcome ◽  
Outcome Data ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Initial Settings ◽  
Patient Prognosis ◽  
Hospital Cardiac Arrest

Introduction: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) has poor outcome. Data about use of extracorporeal membrane oxygenation (ECMO) in PE are heterogenous and there is minimal evidence for its use in patients presenting with r-OHCA. Hypothesis: To describe in detail profile, initial settings of cardiac arrest (CA) and clinical course of patients with PE presenting with r-OHCA and its specifics in comparison to patients with r-OHCA of other cause. The special attention was paid to the use of ECMO and its potential benefit for patient prognosis. Methods: We reanalyzed subgroup of patients with PE from Prague OHCA study - a randomized control trial evaluating the effect of hyperinvasive approach including the use of ECMO in r-OHCA. Patients characteristics, the specifics of CA settings and the outcome were compared to the patients with other cause of r-OHCA. The neurologically favorable survival was then compared between PE patients randomized to Hyperinvasive and Standard arm of the study. Results: The PE was identified as a cause of CA in 24 (9.4 %) patients in Prague OHCA study. PE patients were more likely women (12 [50 %] vs 32 [13.8 %]) with non-shockable initial rhythm (23 [95.8 %] vs 77 [33.2 %]; P < 0.0001). The CA occurs more frequently after arrival of emergency medical service (14 [58.3 %], vs 22 [9.5 %]; P < 0.0001), had shorter time to hospital admission (median in minutes [IQR], 40 [34.5-57.8] vs 54 [46-64]; P = 0.01) with more severe acidosis at admission (median pH [IQR]; 6.83 [6.75-6.88] vs 6.98 [6.82-7.14] P = 0.0008). The primary outcome of patients with PE - CPC 1 or 2 at 180 days - was significantly worse (2 [8.3 %] vs 66 [28.4 %]; P = 0.049). There was non-significant difference in primary outcome - CPC 1 or 2 at 180 days - between PE patients in Hyperinvasive (12 [50%]) and Standard arm of the study (2 [16.7 %] vs 0; P = 0.24). Conclusion: The initial profile of patients and the settings of CA in patients with r-OHCA and PE differs from patients with other CA cause and their prognosis is significantly worse. The Hyperinvasive approach did not improved outcome in this subgroup of patients.

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