scholarly journals Effects of extracorporeal cardiopulmonary resuscitation on neurological and cardiac outcome after ischaemic refractory cardiac arrest

2017 ◽  
Vol 7 (5) ◽  
pp. 432-441 ◽  
Author(s):  
Francesca Cesana ◽  
Leonello Avalli ◽  
Laura Garatti ◽  
Anna Coppo ◽  
Stefano Righetti ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Left Ventricular Ejection Fraction ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Ventricular Ejection Fraction ◽  
Return Of Spontaneous Circulation ◽  
Refractory Cardiac Arrest

Background: Extracorporeal cardiopulmonary resuscitation is increasingly recognised as a rescue therapy for refractory cardiac arrest, nevertheless data are scanty about its effects on neurologic and cardiac outcome. The aim of this study is to compare clinical outcome in patients with cardiac arrest of ischaemic origin (i.e. critical coronary plaque during angiography) and return of spontaneous circulation during conventional cardiopulmonary resuscitation vs refractory cardiac arrest patients needing extracorporeal cardiopulmonary resuscitation. Moreover, we tried to identify predictors of survival after successful cardiopulmonary resuscitation. Methods: We enrolled 148 patients with ischaemic cardiac arrest admitted to our hospital from 2011–2015. We compared clinical characteristics, cardiac arrest features, neurological and echocardiographic data obtained after return of spontaneous circulation (within 24 h, 15 days and six months). Results: Patients in the extracorporeal cardiopulmonary resuscitation group ( n=63, 43%) were younger (59±9 vs 63±8 year-old, p=0.02) with lower incidence of atherosclerosis risk factors than those with conventional cardiopulmonary resuscitation. In the extracorporeal cardiopulmonary resuscitation group, left ventricular ejection fraction was lower than conventional cardiopulmonary resuscitation at early echocardiography (19±16% vs 37±11 p<0.01). Survivors in both groups showed similar left ventricular ejection fraction 15 days and 4–6 months after cardiac arrest (46±8% vs 49±10, 47±11% vs 45±13%, p not significant for both), despite a major extent and duration of cardiac ischaemia in extracorporeal cardiopulmonary resuscitation patients. At multivariate analysis, the total cardiac arrest time was the only independent predictor of survival. Conclusions: Extracorporeal cardiopulmonary resuscitation patients are younger and have less comorbidities than conventional cardiopulmonary resuscitation, but they have worse survival and lower early left ventricular ejection fraction. Survivors after extracorporeal cardiopulmonary resuscitation have a neurological outcome and recovery of heart function comparable to subjects with return of spontaneous circulation. Total cardiac arrest time is the only predictor of survival after cardiopulmonary resuscitation in both groups.

scholarly journals Intra-Arrest Administration of Cyclosporine and Methylprednisolone Does Not Reduce Postarrest Myocardial Dysfunction

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Meshe Chonde ◽  
Katharyn L. Flickinger ◽  
Matthew L. Sundermann ◽  
Allison C. Koller ◽  
David D. Salcido ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Myocardial Dysfunction ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Sampled Data ◽  
Ventricular Ejection Fraction

Objective. To determine whether the administration of intra-arrest cyclosporine (CCY) and methylprednisolone (MP) preserves left ventricular ejection fraction (LVEF) and cardiac output (CO) after return of spontaneous circulation (ROSC). Methods. Eleven, 25-30kg female swine were randomized to receive 10mg/kg CCY + 40mg MP or placebo, anesthetized and given a transthoracic shock to induce ventricular fibrillation. After 8 minutes, standard CPR was started. After two additional minutes, the experimental agent was administered. Animals with ROSC were supported for up to 12h with norepinephrine as needed. Echocardiography was performed at baseline, and 1, 2, 6 and 12h post-ROSC. Analysis was performed using generalized estimating equations (GEE) after downsampling continuously sampled data to 5 minute epochs. Results. Eight animals (64%) achieved ROSC after a median of 7 [IQR 5-13] min of CPR, 2 [ IQR 1-3] doses of epinephrine and 2 [IQR 1-5] defibrillation shocks. Animals receiving CCY+MP had higher post ROSC MAP (GEE coefficient -10.2, P = <0.01), but reduced cardiac output (GEE coefficient 0.8, P = <0.01) compared to placebo. There was no difference in LVEF or vasopressor use between arms. Conclusions. Intra-arrest cyclosporine and methylprednisolone decreased post-arrest cardiac output and increased mean arterial pressure without affecting left ventricular ejection fraction.

Abstract 17412: Current Experience and Limitations of Extracorporeal Cardiopulmonary Resuscitation for Cardiac Arrest: A Single-Center Retrospective Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Aditi Singhvi ◽  
Nirav Patel ◽  
Jason A Gluck
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Selection Criteria ◽  
Spontaneous Circulation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Outcomes ◽  
Time To Initiation ◽  
Central Access ◽  
Refractory Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered for select cardiac arrest patients for whom the suspected etiology of the arrest is potentially reversible. In adults, the survival to discharge with ECPR is reportedly 22% to 33%, with better outcomes for in-hospital arrests. Outcomes with ECPR depend on multiple factors including, location of arrest, etiology, duration and quality of CPR, time to initiation of ECMO, and post-arrest management. There is no consensus regarding patient selection or management of these patients. We report our preliminary experiences with ECPR for refractory cardiac arrest. Methods: Patients who underwent ECPR between January 2013 and May 2018 were identified. The characteristics of the arrest, CPR duration, cannulation procedure, post-arrest management, complications, survival and neurologic outcomes were retrospectively reviewed. Results: A total of 24 ECPR events were identified. The median age was 60 years. The median CPR duration and time from collapse to initiation of ECMO were 35 (IQR 25.5-68) and 68 (IQR 45.5-144.5) min, respectively. Peripheral and central access sites were employed in 19 and 5 cases, respectively. Return of spontaneous circulation was achieved in 21 patients (87.5%). PCI was performed on 4 and pulmonary embolectomy on 3 patients. Median duration of ECMO support was 84 (IQR 24-168) hours. Major complications occurred in 17 patients (70.8%). Nine patients (37.5%) were successfully weaned from ECMO and 7 (29.2%) survived to hospital discharge. All of the survivors had a favorable neurologic outcome. Conclusions: ECPR as part of a comprehensive multi-faceted approach for select patients with refractory cardiac arrest may improve outcomes. We noted an improvement in outcomes over time. This could be attributed to improved selection criteria as well as clinical management. The development of selection criteria may help identify patients most likely to benefit from the use of ECPR. This would have significant resource implications for hospitals with ECMO programs.

scholarly journals Prompt extracorporeal cardiopulmonary resuscitation with left ventricular unloading by IMPELLA improves the outcome of patients with refractory cardiac arrest: A single-site retrospective cohort study

2021 ◽  
Author(s):  
Takashi Unoki ◽  
Yudai Tamura ◽  
Motoko Hirai ◽  
Hiroto Suzuyama ◽  
Masayuki Inoue ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Clinical Outcome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Left Ventricular ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Va Ecmo ◽  
Refractory Cardiac Arrest

Abstract Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest (CA). However, VA-ECMO increases damaged left ventricular (LV) afterload. The percutaneous microaxial pump Impella can reduce LV preload with simultaneous circulatory support, which may have a significant effect on clinical outcome by concomitant use of VA-ECMO and IMPELLA (ECPELLA). In the current retrospective cohort study, we assessed factors affecting the outcome of CA patients who underwent E-CPR.Method: We retrospectively reviewed 149 consecutive CA patients with E-CPR from January 2012 through December 2020 in our institute. Patients were divided into three groups: ECEPLLA (n=29), IABP + VA-ECMO (n=78), and single VA-ECMO (n=42). We assessed 30-day survival and neurological outcome using cerebral performance categories (CPCs).Results: There were no significant differences in age, sex, out-of-hospital CA, or acute coronary syndrome among the groups. ECPELLA showed the highest cumulative 30-day survival (ECPELLA: 55%, IABP + VA-ECMO: 23%, VA-ECMO: 9.5; p=0.001) and the rates of CPC score 1 or 2 (ECPELLA: 31%, IABP + VA-ECMO: 13%, VA-ECMO: 7%; p=0.02). Multivariate analysis revealed that age (hazard ratio [HR], 1.30, 95% confidence interval [CI], 1.13-1.52, P=0.005) and time from CA to ECMO support (HR, 1.22, 95% CI, 1.13-1.31, P<0.0001) and ECPELLA (HR, 0.46, 95% CI, 0.24-0.88, P=0.02) were significantly associated with the clinical outcome.Conclusion: Earlier initiation of E-CPR is critical to improve patient survival and neurological outcome. Additional Impella support, ECPELLA, appears to significantly improve the clinical outcome.

Abstract 14195: Impact of Leukocyte Filtration and Leukocyte Modulation on Recovery of Heart Function After Prolonged Cardiac Arrest Treated With ECPR in a Porcine Model

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jensyn VanZalen ◽  
Takahiro Nakashima ◽  
Annie Phillips ◽  
Joseph Hill ◽  
Alyssa Enciso ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Function ◽  
Heart Function ◽  
Randomized Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Swine Model ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Ventricular Ejection Fraction

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) improves survival of patients with prolonged cardiac arrest (CA) that is refractory to standard CPR and ACLS. It has been proposed that ECPR accentuates inflammation after CA, potentially limiting its effectiveness. The benefits of leukocyte filters or leukocyte-modulating devices in conjunction with ECPR have not been studied. Hypothesis: When paired with ECPR, inflammation-modulating devices targeting leukocytes may improve recovery of cardiac function after prolonged cardiac arrest. Methods: In a randomized study, 24 swine (40±5kg) underwent 8min of untreated ventricular fibrillation CA followed by CPR with mechanical chest compressions and impedance threshold device for 30 min (total arrest time = 38min), immediately followed by 8h of ECPR with heparin anticoagulation and temperature maintained at 33°C. Group 1 (n=8) had standard ECPR system (control), Group 2 (n=8) had a leukocyte filter device (LF) added to the ECPR circuit, an and Group 3 (n=8) had a leukocyte modulation device (LMOD) added to the ECPR circuit. Recovery of cardiac function was measured using a cardiac resuscitablity score (CRS) and left ventricular ejection fraction (LVEF) via transthoracic echocardiography. Data was collected at baseline (prior CA) and after 8h of ECPR. Data analysis: single-factor ANOVA test (p<0.05 significance). Results: There were no statically significant differences between the groups in CRS (Control = 3.3 ± 2.4, LF = 4.0 ± 2.8, LMOD = 2.1 ± 2.6; p=0.37) or LVEF (Control = 59% ± 27%, LF = 49% ± 29% LMOD = 34% ± 38%: p=0.34) at 8 hours after ECPR initiation (Table 1). Discussion: In this swine model of prolonged cardiac arrest treated with ECPR, addition of a leukocyte filter or leukocyte modulation device to the ECPR circuit did not improve recovery of cardiac function during the first 8 hours after initiating ECPR.

scholarly journals Case Report: Left Ventricular Unloading Using a Mechanical CPR Device in a Prolonged Accidental Hypothermic Cardiac Arrest Treated by VA-ECMO – a Novel Approach

2021 ◽  
Vol 8 ◽  
Author(s):  
Simon A. Amacher ◽  
Jonas Quitt ◽  
Eva Hammel ◽  
Urs Zenklusen ◽  
Ayham Darwisch ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Alcohol Intoxication ◽  
Kidney Injury ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Severe Injuries ◽  
Return Of Spontaneous Circulation ◽  
Multiple Rib Fractures ◽  
Novel Approach

We recently treated a 36-year-old previously healthy male with a prolonged hypothermic (lowest temperature 22.3°C) cardiac arrest after an alcohol intoxication with a return of spontaneous circulation after 230min of mechanical cardiopulmonary resuscitation and rewarming by veno-arterial ECMO with femoral cannulation and retrograde perfusion of the aortic arch. Despite functional veno-arterial ECMO, we continued mechanical cardiopulmonary resuscitation (Auto Pulse™ device, ZOLL Medical Corporation, Chelmsford, USA) until return of spontaneous circulation to prevent left ventricular distention from persistent ventricular fibrillation. The case was further complicated by extensive trauma caused by mechanical cardiopulmonary resuscitation (multiple rib fractures, significant hemothorax, and a liver laceration requiring massive transfusion), lung failure necessitating a secondary switch to veno-venous ECMO, and acute kidney injury with the need for renal replacement therapy. Shortly after return of spontaneous circulation, the patient was already following commands and could be discharged 3 weeks later without neurologic, cardiac, or renal sequelae and being entirely well. Prolonged accidental hypothermic cardiac arrest might present with excellent outcomes when supported with veno-arterial ECMO. Until return of spontaneous circulation, one might consider continuing with mechanical cardiopulmonary resuscitation in addition to ECMO to allow some left ventricular unloading. However, the clinician should keep in mind that prolonged mechanical cardiopulmonary resuscitation may cause severe injuries.

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