scholarly journals Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Brendan Lee ◽  
Adam Clay ◽  
Eric Sy
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Clinical Criteria ◽  
Neurological Outcomes ◽  
University Of British Columbia ◽  
The University ◽  
Hospital Cardiac Arrest

Abstract Objectives To evaluate the number of out-of-hospital cardiac arrest (OHCA) patients eligible for extracorporeal cardiopulmonary resuscitation (ECPR) in Saskatchewan and their clinical outcomes, including survival and neurological outcomes at discharge. ECPR eligibility was assessed, using clinical criteria from the University of British Columbia (UBC, Canada), University of Michigan (UM, United States), University of California (UC, United States) and a restrictive ECPR criteria. Results We performed a retrospective cohort study of 200 OHCA patients (August 1, 2017-May 31, 2019) in Regina, Saskatchewan. Sixty-one (30%) were female, the median age was 64 years (interquartile range [IQR], 52–78), the median CPR duration was 30 min (IQR 12–47), and 20% survived to discharge. Two (1%) patients received ECPR but did not meet any ECPR criteria. Nineteen (10%), thirty (15%), twenty-two (11%), and seven (4%) patients were ECPR-eligible, using the UBC, UM, UC, and restrictive criteria. However, none of these patients had received ECPR. Only two (11%), two (7%), two (9%), and one (14%) of these patient(s) survived to discharge, respectively. Neurological outcomes were unfavourable among all ECPR-eligible patients. Future study at our centre will be necessary on how to implement ECPR program to further improve these outcomes.

Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients

2021 ◽  
Author(s):  
Brendan Lee ◽  
Adam Clay ◽  
Eric Sy
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
University Of Michigan ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Clinical Criteria ◽  
Neurological Outcomes ◽  
University Of British Columbia ◽  
The University ◽  
Hospital Cardiac Arrest

Abstract Objectives To evaluate the number of out-of-hospital cardiac arrest (OHCA) patients eligible for extracorporeal cardiopulmonary resuscitation (ECPR) in Saskatchewan and their clinical outcomes, including survival and neurological outcomes at discharge. ECPR eligibility was assessed, using clinical criteria from the University of British Columbia (UBC), University of Michigan (UM), University of California (UC) and a restrictive ECPR criteria. Results We performed a retrospective cohort study of 200 OHCA patients (August 1, 2017-May 31, 2019) in Regina, Saskatchewan. Sixty-one (30%) were female, the median age was 64 years (interquartile range [IQR], 52–78), the median CPR duration was 30 minutes (IQR 12–47), and 20% survived to discharge. Two (1%) patients received ECPR but did not meet any ECPR criteria. Nineteen (10%), thirty (15%), twenty-two (11%), and seven (4%) patients were ECPR-eligible, using the UBC, UM, UC, and restrictive criteria. However, none of these patients had received ECPR. Only two (11%), two (7%), two (9%), and one (14%) of these patient(s) survived to discharge, respectively. Neurological outcomes were unfavourable among all ECPR-eligible patients. Future study at our centre will be necessary on how to implement ECPR program to further improve these outcomes.

scholarly journals P065: Out-of-hospital cardiac arrest patients eligible for extracorporeal cardiopulmonary resuscitation in Regina emergency departments

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S87-S88
Author(s):  
B. Lee ◽  
E. Sy ◽  
A. Clay
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Departments ◽  
Survival Rates ◽  
Annual Number ◽  
Unexpected Death ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is a rapidly evolving technology for clinical use in patients with refractory cardiogenic arrest. Out-of-hospital cardiac arrest (OHCA) is a common cause of unexpected death and has a low survival rate. There is increasing evidence that suggests better outcomes for (OHCA) patients, including improved neurological outcomes and survival rates, who are started on extracorporeal corporeal membrane oxygenation (ECMO) versus traditional resuscitation methods. Methods: We conducted a retrospective chart review of 200 out-of-hospital cardiac arrest patients presenting to Regina emergency departments from January 1, 2017 to March 31, 2019. Eligibility for ECPR was assessed using different clinical criteria from different ECPR programs (University of British Columbia, University of Michigan, and a hypothetical “Regina” criteria created for this study). Outcomes of the eligible patients were compared using descriptive statistics with SPSS version 22. Results: Between four different criteria, 15%, 9.5%, 7.5%, and 3.5% of patients were respectively eligible to receive ECPR. Of patients who met eligibility for all four criteria, 80% were male, the average age was 61 years old, the average Cerebral Performance score was 4.46, and 83% died in hospital. There was a low survival rate of eligible patients, with rates of 16%, 17%, 20%, and 28% in each group. The survival rate for all patients was 21% and the average CPC score was 4.35. Conclusion: The significant percentage of patients were eligible for ECPR upon presentation to Regina Emergency Departments. Patients who were eligible had low survival rates and poor neurological outcomes, suggesting that ECPR could prove to be a valuable clinical tool that could improve patient outcomes in Saskatchewan. There were considerable differences in patient eligibility percentages based on different criterion. Differences in inclusion/exclusion criteria, modifying the expected annual number of ECPR eligible OHCA patients, could provide valuable information on required resources and planning for implementation of an ECPR program in a smaller centre, such as Regina.

scholarly journals Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

2021 ◽  
Vol 29 (3) ◽  
pp. 311-319
Author(s):  
Mustafa Emre Gürcü ◽  
Şeyhmus Külahçıoğlu ◽  
Pınar Karaca Baysal ◽  
Serdar Fidan ◽  
Cem Doğan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular Ejection ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
Hospital Cardiac Arrest

Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients. Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded. Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%. Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

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 ◽  
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.

scholarly journals Survival Outcomes of In-Hospital Cardiac Arrest in Pediatric Patients in the United States

2021 ◽  
Author(s):  
Mohammed Hamzah ◽  
Hasan F. Othman ◽  
Murad Almasri ◽  
Awni Al-Subu ◽  
Riad Lutfi
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Nationwide Inpatient Sample ◽  
Heart Surgery ◽  
The United States ◽  
Congenital Heart Surgery ◽  
Teaching Hospitals ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Abstract We report on in-hospital cardiac arrest outcomes in the United States. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000–2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest and we excluded patients with no cardiopulmonary resuscitation during the hospitalization. Primary outcome of the study was in-hospital mortality after cardiac arrest. A multivariable logistic regression was performed to identify factors associated with survival. A total of 20,654 patients were identified, 8226 (39.82%) patients survived to discharge. The median length of stay and cost of hospitalization were significantly higher in the survivors vs. Non- survivors (LOS 18 days vs. 1 day, and cost $187,434 vs. $45,811, respectively, p < 0.001). In a multivariable model, patients admitted to teaching hospitals, elective admissions and those admitted on weekdays had higher survival (aOR=1.19, CI: 1.06–1.33, aOR=2.65, CI: 2.37–2.97 and aOR=1.17, CI: 1.07–1.27, respectively). Acute renal failure was associated with decrease in survival (aOR=0.66, CI: 0.60–0.73). There was no difference in mortality between patients with Extracorporeal CardioPulmonary Resuscitation (E-CPR) and those with conventional CardioPulmonary Resuscitation. E-CPR patients were likely to have congenital heart surgery (51.0% vs. 20.8%). In conclusion, we highlighted the survival predictors in these events, which can guide future studies aimed at improving outcomes in pediatric cardiac arrest.

Sign in / Sign up

Export Citation Format

Share Document