Targeted temperature management in patients undergoing extracorporeal life support after out-of-hospital cardiac arrest: an EURO-ELSO 2018 annual conference survey

Perfusion ◽  
2019 ◽  
Vol 34 (8) ◽  
pp. 714-716
Author(s):  
Caroline Rolfes ◽  
Ralf M Muellenbach ◽  
Philipp M Lepper ◽  
Tobias Spangenberg ◽  
Justyna Swol ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bleeding Risk ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Annual Conference ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Targeted temperature management and extracorporeal life support, particularly extracorporeal membrane oxygenation in patients undergoing cardiopulmonary resuscitation, represent outcome-enhancing strategies for patients following in- and out-of-hospital cardiac arrest. Although targeted temperature management with hypothermia between 32°C and 34°C and extracorporeal cardiopulmonary resuscitation bear separate potentials to improve outcome after out-of-hospital cardiac arrest, each is associated with bleeding risk and risk of infection. Whether the combination imposes excessive risk on patients is, however, unknown.

scholarly journals Extracorporeal Cardiopulmonary Resuscitation for Out‐of‐Hospital Cardiac Arrest in Adult Patients

2020 ◽  
Vol 9 (7) ◽  
Author(s):  
Akihiko Inoue ◽  
Toru Hifumi ◽  
Tetsuya Sakamoto ◽  
Yasuhiro Kuroda
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
The United States ◽  
Adult Patients ◽  
Temperature Management ◽  
Secondary Brain Injury ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out‐of‐hospital cardiac arrest (OHCA) in adult patients. Although recent narrative and systematic reviews on extracorporeal life support in the emergency department are available in the literature, they are focused on the efficacy of ECPR, and no comprehensively summarized review on ECPR for OHCA in adult patients is available. In this review, we aimed to clarify the prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, with the aim of facilitating understanding among acute care physicians. The leading countries in the field of ECPR are those in East Asia followed by those in Europe and the United States. ECPR may reduce the risks of reperfusion injury and deterioration to secondary brain injury. Unlike conventional cardiopulmonary resuscitation, however, no clear prognostic markers have been identified for ECPR for OHCA. Bleeding was identified as the most common complication of ECPR in patients with OHCA. Future studies should combine ECPR with intra‐aortic balloon pump, extracorporeal membrane oxygenation flow, target blood pressure, and seizure management in ECPR.

scholarly journals 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Jonathan P. Duff ◽  
Alexis A. Topjian ◽  
Marc D. Berg ◽  
Melissa Chan ◽  
Sarah E. Haskell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
Life Support ◽  
American Heart ◽  
Heart Association ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Liaison Committee ◽  
Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post–cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.

Target Temperature Management May Not Improve Clinical Outcomes of Extracorporeal Cardiopulmonary Resuscitation

2018 ◽  
Vol 34 (10) ◽  
pp. 790-796 ◽  
Author(s):  
Young Su Kim ◽  
Yang Hyun Cho ◽  
Kiick Sung ◽  
Jeong-Am Ryu ◽  
Chi Ryang Chung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Hospital Survival

Purpose: Target temperature management (TTM) and extracorporeal cardiopulmonary resuscitation (ECPR) have been established as important interventions during cardiopulmonary arrest. However, the impact of combined TTM and ECPR on clinical outcomes has not been studied in detail. Methods: We reviewed the records of 245 patients who received extracorporeal life support (ECLS) between January 2012 and June 2015. Exclusion criteria were as follows: Extracorporeal life support performed for reasons other than cardiac arrest, age less than 18 years, and death within 24 hours. A total of 101 patients were finally included in the study. Twenty-five patients underwent TTM, and 76 patients did not. Results: The patients’ mean age was 55 ± 16.7 years. The mean cardiac arrest time was 44.6 ± 33.5 minutes. There were 84 patients whose cardiac arrest was due to a cardiac cause (83.2%) and 79 patients with in-hospital cardiac arrest (78.2%). There was a significant difference in average body temperature during the first 24 hours following ECPR (33.4°C vs 35.6°C; P = .001). The overall favorable neurological outcome rate was 34% and hospital survival rate was 47%. There was no difference in favorable neurological outcomes and hospital survival between the TTM and non-TTM groups ( P = .91 and .84, respectively). On multivariate analysis of neurological outcomes and hospital survival, TTM was not a significant prognostic factor. Conclusion: We did not observe any benefits of TTM in patients undergoing ECPR. Natural hypothermia or normothermia related to ECLS may explain this result. Further research is needed to understand the role of TTM in ECPR.

Cardiac Resuscitation

2019 ◽  
Author(s):  
Samuel A Tisherman
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Early Recognition ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Optimal Timing ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Hospital Cardiac Arrest

Sudden cardiac death, whether in the hospital or out of the hospital, is a leading cause of death. Early recognition and activation of an emergency response, following the “chain of survival”, is critical. High quality Cardiopulmonary Resuscitation (CPR) should be initiated as soon as possible. Rescue breaths can be added when a qualified medical professional is available. Once emergency medical services personnel arrive for an out of hospital cardiac arrest or the “code team” arrives for an in hospital cardiac arrest, the Advanced Cardiovascular Life Support (ACLS) algorithm should be followed. For patients with pulseless ventricular tachycardia or ventricular fibrillation, early defibrillation improves the chances for restoration of spontaneous circulation and survival. The use of vasopressors and anti-arrhythmics are part of the protocol, though the benefits are unclear. Once trained airway providers are available, placement of an advanced airway, either supraglottic or endotracheal, can be considered after several minutes of CPR-ACLS, though optimal timing and clear benefit have not been established. For patients who remain comatose after resuscitation, initiation of Targeted Temperature Management can improve outcomes. Neuroprognostication is complex and should be delayed for at least 3-5 days after resuscitation and should be based upon multiple sources of information. This review contains 1 figure, 5 tables, and 44 references. Keywords: Cardiac arrest, cardiopulmonary resuscitation, anti-arrhythmics, airway management, targeted temperature management, prognostication 

Cardiac Resuscitation

2019 ◽  
Author(s):  
Samuel A Tisherman
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Early Recognition ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Optimal Timing ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Hospital Cardiac Arrest

Sudden cardiac death, whether in the hospital or out of the hospital, is a leading cause of death. Early recognition and activation of an emergency response, following the “chain of survival”, is critical. High quality Cardiopulmonary Resuscitation (CPR) should be initiated as soon as possible. Rescue breaths can be added when a qualified medical professional is available. Once emergency medical services personnel arrive for an out of hospital cardiac arrest or the “code team” arrives for an in hospital cardiac arrest, the Advanced Cardiovascular Life Support (ACLS) algorithm should be followed. For patients with pulseless ventricular tachycardia or ventricular fibrillation, early defibrillation improves the chances for restoration of spontaneous circulation and survival. The use of vasopressors and anti-arrhythmics are part of the protocol, though the benefits are unclear. Once trained airway providers are available, placement of an advanced airway, either supraglottic or endotracheal, can be considered after several minutes of CPR-ACLS, though optimal timing and clear benefit have not been established. For patients who remain comatose after resuscitation, initiation of Targeted Temperature Management can improve outcomes. Neuroprognostication is complex and should be delayed for at least 3-5 days after resuscitation and should be based upon multiple sources of information. This review contains 1 figure, 5 tables, and 44 references. Keywords: Cardiac arrest, cardiopulmonary resuscitation, anti-arrhythmics, airway management, targeted temperature management, prognostication 

Cardiac Resuscitation

2019 ◽  
Author(s):  
Samuel A Tisherman
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Early Recognition ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Optimal Timing ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Hospital Cardiac Arrest

Sudden cardiac death, whether in the hospital or out of the hospital, is a leading cause of death. Early recognition and activation of an emergency response, following the “chain of survival”, is critical. High quality Cardiopulmonary Resuscitation (CPR) should be initiated as soon as possible. Rescue breaths can be added when a qualified medical professional is available. Once emergency medical services personnel arrive for an out of hospital cardiac arrest or the “code team” arrives for an in hospital cardiac arrest, the Advanced Cardiovascular Life Support (ACLS) algorithm should be followed. For patients with pulseless ventricular tachycardia or ventricular fibrillation, early defibrillation improves the chances for restoration of spontaneous circulation and survival. The use of vasopressors and anti-arrhythmics are part of the protocol, though the benefits are unclear. Once trained airway providers are available, placement of an advanced airway, either supraglottic or endotracheal, can be considered after several minutes of CPR-ACLS, though optimal timing and clear benefit have not been established. For patients who remain comatose after resuscitation, initiation of Targeted Temperature Management can improve outcomes. Neuroprognostication is complex and should be delayed for at least 3-5 days after resuscitation and should be based upon multiple sources of information. This review contains 1 figure, 5 tables, and 44 references. Keywords: Cardiac arrest, cardiopulmonary resuscitation, anti-arrhythmics, airway management, targeted temperature management, prognostication 

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

2021 ◽  
pp. 088506662110189
Author(s):  
Merry Huang ◽  
Aaron Shoskes ◽  
Migdady Ibrahim ◽  
Moein Amin ◽  
Leen Hasan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Survival Outcomes ◽  
Pool Data ◽  
Good Neurological Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Over Time

Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

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