Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Abstract Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR. Methods We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths. Results Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Conclusion In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

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Hyperoxia During Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest Is Associated With Severe Circulatory Failure and Increased Mortality

10.21203/rs.3.rs-659017/v1 ◽

2021 ◽

Author(s):

Jean Bonnemain ◽

Marco Rusca ◽

Zied Ltaief ◽

Aurélien Roumy ◽

Piergiorgio Tozzi ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Circulatory Failure ◽

Arterial Oxygen ◽

Limited Information ◽

Neurological Damage ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Arterial Blood ◽

The Mean

Abstract Background: High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR.Methods: We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths.Results: Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24h PaO2 (306±121 mmHg vs 164±53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24h (an index of native cardiac recovery). The mean 24h PaO2 was significantly correlated with hypotension and vasoactive therapies. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Patients dying from circulatory failure died after a median of 17h, compared to a median of 58 h for patients dying from a neurological cause (OR 0.95, 95% CI 0.90–0.99, p = 0.001).Conclusion: In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.0.8877 ◽

2020 ◽

pp. 1-6

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.2020.8877 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

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Extracorporeal cardiopulmonary resuscitation for post-operative cardiac arrest: indications, techniques, controversies, and early results – what is known (and unknown)

Cardiology in the Young ◽

10.1017/s1047951111001685 ◽

2011 ◽

Vol 21 (S2) ◽

pp. 109-117 ◽

Cited By ~ 21

Author(s):

Paul J. Chai ◽

Jeffrey P. Jacobs ◽

Heidi J. Dalton ◽

John M. Costello ◽

David S. Cooper ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Membrane Oxygenation ◽

Cardiac Disease ◽

Blood Gases ◽

Arterial Blood Gases ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Arterial Blood ◽

Selection Of Patients ◽

Selection Of

AbstractExtracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.

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Abstract 154: Hyperoxemia is Associated with Poor Neurological Outcomes in Patients with Out-of-hospital Cardiac Arrest Rescued by Extracorporeal Cardiopulmonary Resuscitation: Insight From the Nationwide Multicenter Observational JAAM-OHCA (Japan Association for Acute Medicine) Registry

Circulation ◽

10.1161/circ.142.suppl_4.154 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Masaaki Nishihara ◽

Ken-ichi Hiasa ◽

Nobuyuki Enzan ◽

Kenzo Ichimura ◽

Takeshi Iyonaga ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Control Group ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Acute Medicine ◽

Neurological Outcomes ◽

Arterial Blood ◽

And Control ◽

Hospital Cardiac Arrest

Introduction: Previous studies have shown an association between hyperoxemia and mortality in out-of-hospital cardiac arrest (OHCA) patients after cardiopulmonary resuscitation (CPR); however, the evidence is lacking in patients receiving extracorporeal CPR (ECPR). Hypothesis: To test the hypothesis that hyperoxemia is associated with poor neurological outcome in patients treated by ECPR. Methods: The Japanese Association for Acute Medicine - OHCA (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients who had been resuscitated and survived 24 hours after OHCA and had a PaO 2 levels above 60 mmHg were included. Eligible patients were divided into 2 groups by each 2 definition according to the PaO 2 levels measured from arterial blood gas analysis 24-h after the ECPR, (1) High-level of PaO 2 (H-PaO 2 , n=242) as PaO 2 ≥ 157 mmHg (median) and control (n=211) as 60 < PaO 2 < 157 mmHg, (2) hyperoxemia (HO, n=80) as PaO 2 ≥ 300 mmHg and control (n=373) as 60 < PaO 2 < 300 mmHg. The primary and secondary outcomes were the favorable neurological outcome, defined as Cerebral Performance Categories (CPC) Scale 1-2, and survival at 30 days after OHCA, respectively. Results: Out of 34,754 patients with OHCA, 453 patients with ECPR were included. The number of CPC 1-2 was significantly lower in the H-PaO 2 and HO group compared with each control group (H-PaO 2 : 17.4% vs. 33.2%; Odds ratio [OR] 0.42; 95% confidence interval [CI] 0.27-0.66; P<0.0001, HO: 8.8% vs. 28.2%; OR 0.24; 95% CI 0.11-0.55; P<0.001). The 30-day survival was lower in these high oxygen groups (H-PaO 2 : 39.3% vs. 57.4%; OR 0.48; 95% CI 0.33-0.70; P<0.0001, HO: 25.0% vs. 52.6%; OR 0.30; 95% CI 0.17-0.52; P<0.0001). After adjusting for potential confounders, the H-PaO 2 and HO were associated with unfavorable neurological outcomes (adjusted OR, H-PaO 2 ; 2.71; 95% CI 1.16-6.30; P=0.021, HO; 5.76; 95% CI 1.30-25.4; P=0.021). The H-PaO 2 and HO were also associated with poor 30-day survival (adjusted OR, H-PaO 2 ; 2.28; 95% CI 1.13-4.60; P=0.021, HO; 3.75; 95% CI 1.28-11.0; P=0.016). Conclusions: Hyperoxemia was associated with worse neurological outcomes in OHCA patients with ECPR.

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A Comparison of the Effects of Dexmedetomidine and Propofol in Controlling the Hemodynamic Responses after Intubation: A Double-Blind, Randomized, Clinical Trial Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.385 ◽

2018 ◽

Vol 6 (11) ◽

pp. 2045-2050

Author(s):

Alireza Kamali ◽

Mehrdad Taghizadeh ◽

Mohtaram Esfandiar ◽

Amin Shams Akhtari

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Tracheal Intubation ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Endotracheal Intubation ◽

Arterial Oxygen ◽

Arterial Blood ◽

The Mean ◽

Group D

AIM: This study aimed to compare the effects of dexmedetomidine and propofol in controlling the hemodynamic response following intubation of patients’ candidate intubation in the emergency department METHODS: A total of 114 patients were randomly assigned to one of 2 groups to receive one of the following treatments: dexmedetomidine 0.4 µg/kg (Group D, n = 57) and propofol 1–1.5 mg/kg/h (Group P, n = 57). Hemodynamic data such as the systolic blood pressure, diastolic blood pressure, arterial oxygen saturation and heart rate (HR) were recorded from the entrance to operation room to 5, 10 and 15 min after tracheal intubation RESULTS: Compared with group D, group P exhibited increases in mean arterial blood pressure (MAP), and systolic blood pressure significantly at all times and immediately after the endotracheal intubation. Moreover, the mean diastolic blood pressure changes due to tracheal intubation in group P were significantly more than group D immediately after the intubation. Furthermore, the mean heart rate changes immediately and 5 min after tracheal intubation was significantly higher in group P CONCLUSION: Our data suggest that the benefits of dexmedetomidine more than propofol in hemodynamic stability because propofol was associated with more variability in systolic/diastolic blood pressure, HR and MAP after endotracheal intubation.

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Sustained Inflation During Chest Compression: A New Technique of Pediatric Cardiopulmonary Resuscitation That Improves Recovery and Survival in a Pediatric Porcine Model

Journal of the American Heart Association ◽

10.1161/jaha.120.019136 ◽

2021 ◽

Author(s):

Georg M. Schmölzer ◽

Siddhi D. Patel ◽

Sveva Monacelli ◽

Seung Yeon Kim ◽

Gyu‐Hong Shim ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Arterial Blood Pressure ◽

Chest Compression ◽

Cerebral Oxygenation ◽

Group Versus ◽

Fold Increase ◽

Arterial Blood ◽

Sustained Inflation

Background Chest compression (CC) during sustained inflations (CC+SI) compared with CC with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation in asphyxiated pediatric piglets will reduce time to return of spontaneous circulation (ROSC). Methods and Results Piglets (20–23 days of age, weighing 6.2–10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure <25 mm Hg with bradycardia. After cardiac arrest, piglets were randomized to CC+SI (n=12) or CCaV (n=12) or sham (n=8). Sham‐operated animals had no asphyxia. Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded. There were no differences in baseline parameters or the duration and degree of asphyxiation. Median (interquartile range) Time to ROSC was 248 (41–346) seconds compared with 720 (167–720) seconds in the CC+SI group and CCaV group, respectively ( P =0.0292). There was a 100% higher rate of ROSC in the CC+SI group versus CCaV group, with 10 (83%) versus 5 (42%) achieving ROSC ( P =0.089), respectively. Piglets in the CC+SI and CCaV groups received intravenous epinephrine boluses to achieve ROSC (8/12 versus 10/12 P =0.639). There was a significantly higher minute ventilation in the CC+SI group, which was secondary to a 5‐fold increase in the number of inflations per minute and a 1.5‐fold increase in tidal volume. Conclusions CC+SI reduced time to ROSC and improved survival compared with using CCaV. CC+SI allowed passive ventilation of the lung while providing chest compressions. This technique warrants further studies to examine the potential to improve outcomes in pediatric patients with cardiac arrest. Registration URL: https://www.preclinicaltrials.eu ; Unique identifier: PCTE0000152.

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American Heart Association cardiopulmonary resuscitation quality targets are associated with improved arterial blood pressure during pediatric cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2012.08.335 ◽

2013 ◽

Vol 84 (2) ◽

pp. 168-172 ◽

Cited By ~ 44

Author(s):

Robert M. Sutton ◽

Benjamin French ◽

Akira Nishisaki ◽

Dana E. Niles ◽

Matthew R. Maltese ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Arterial Blood Pressure ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Arterial Blood

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Abstract 174: Cost-Utility Analysis of Extracorporeal Cardiopulmonary Resuscitation in Patients With Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.174 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Murtaza Bharmal ◽

Joseph Venturini ◽

Rhys Chua ◽

Willard Sharp ◽

David Beiser ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

The United States ◽

Cost Utility ◽

Health Utilities Index ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Health Utilities ◽

Definitive Therapy ◽

The Mean ◽

The Cost

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) provides cardiac and respiratory support and serves as a bridge to definitive therapy or to recovery. However, ECPR is resource intensive and evidence of clear survival benefit is lacking. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution. Methods: We performed a retrospective review of ECPR patients who suffered cardiac arrest at our institution between 2012 and 2017. Charges for all medical care associated with ECPR and subsequent hospital care were recorded, including direct costs, indirect costs, operating costs and payer charges. The quality-of-life status of survivors was assessed with the Health Utilities Index Mark II. Results: ECPR was instituted in 24 patients (54% in-hospital [13 of 24]), mean age 49.8 ± 17.3 years, 71% male (17 of 24), and 58% African American (14 of 24). The mean and median duration of ECMO support was 3.2 and 2.7 days, respectively. The mean and median of total length of stay was 13.4 and 7.5 days, respectively. Survival to hospital discharge and 1-year survival were 17% (4 of 24) and 13% (3 of 23), respectively. The mean score of the Health Utilities Index Mark II at discharge for the survivors was 0.53 ± 0.23 (range, 0.32-0.84). The average operating cost for patients undergoing ECMO was $188,197 per patient. The calculated cost-utility for ECPR was $59,449/QALY gained. Conclusions: The calculated cost-utility for ECPR is within the threshold considered cost-effective in the United States (<$100,000/QALY gained). These results are comparable to the cost-effectiveness of orthotopic heart transplantation for end-stage heart failure. Larger studies are needed to assess the cost-utility of ECPR and to identify whether other factors, such as patient characteristics and type of cannula, may affect the cost-utility benefit.

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