Microdialysis Assessment of Cerebral Perfusion during Cardiac Arrest, Extracorporeal Life Support and Cardiopulmonary Resuscitation in Rats – A Pilot Trial

Abstract This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.

Download Full-text

A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2012.07.009 ◽

2012 ◽

Vol 83 (11) ◽

pp. 1331-1337 ◽

Cited By ~ 132

Author(s):

Assad Haneya ◽

Alois Philipp ◽

Claudius Diez ◽

Simon Schopka ◽

Thomas Bein ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support

Download Full-text

Neonatal Kawasaki syndrome presenting as out of hospital cardiac arrest rescued by extracorporeal cardiopulmonary resuscitation

Perfusion ◽

10.1177/0267659119847438 ◽

2019 ◽

Vol 35 (1) ◽

pp. 86-88

Author(s):

Marguerite Tyson ◽

Ala Mustafa ◽

Prem Venugopal ◽

Ben Whitehead ◽

Ben Anderson ◽

...

Keyword(s):

Cardiac Arrest ◽

Kawasaki Disease ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support ◽

Pediatric Intensive Care ◽

Kawasaki Syndrome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Diagnostic Uncertainty ◽

Local Emergency Department

A 7-week-old girl presented in severe shock to a local emergency department. During transfer to the quaternary pediatric hospital, the child had a cardiac arrest and cardiopulmonary resuscitation was commenced en route. Upon arrival to the pediatric intensive care unit, extracorporeal life support was initiated via trans-sternal cannulation. Chest CT performed after extracorporeal life support cannulation, demonstrated widespread aneurysms and a diagnosis of Kawasaki disease was made. Immunomodulatory therapy with immunoglobulin and glucocorticoid medication was commenced and the child was separated from extracorporeal life support after 48 hours. Our case highlights both an unusual presentation of Kawasaki disease and the role extracorporeal cardiopulmonary resuscitation can play in the treatment of this disease. It describes the youngest reported patient in the literature with Kawasaki disease rescued by extracorporeal cardiopulmonary resuscitation and highlights how extracorporeal life support therapy can facilitate appropriate investigations to resolve diagnostic uncertainty and treat the underlying condition.

Download Full-text

Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support

Resuscitation ◽

10.1016/j.resuscitation.2010.03.037 ◽

2010 ◽

Vol 81 (8) ◽

pp. 968-973 ◽

Cited By ~ 159

Author(s):

Eisuke Kagawa ◽

Ichiro Inoue ◽

Takuji Kawagoe ◽

Masaharu Ishihara ◽

Yuji Shimatani ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support ◽

Hospital Cardiac Arrest

Download Full-text

Refractory cardiac arrrest treated with extracorporeal cardiopulmonary resuscitation, 2-year follow-up

European Heart Journal ◽

10.1093/ehjci/ehaa946.1820 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Kruger ◽

P Ostadal ◽

M Janotka ◽

J Naar ◽

D Vondrakova ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Clinical Outcomes ◽

Blood Lactate ◽

Life Support ◽

Extracorporeal Life Support ◽

Funding Source ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Lactate Levels ◽

Refractory Cardiac Arrest

Abstract Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) has been introduced as a life-saving procedure in refractory cardiac arrest. Methods Eligible patients for this analysis had to undergo ECPR after unsuccessful cardiopulmonary resuscitation with a minimum of three defibrillation attempts. For extracorporeal life support (ECLS) was used Cardiohelp system or Levitronix CentriMag blood pump. LUCAS II system was used for chest compressions during cardiac arrest. The relations of blood lactate and pH levels, measured before ECPR insertion and after 24 hours as well as comorbities (diabetes, hypertension, BMI) to the clinical outcomes at 2 years were evaluated. Results We analyzed data from 59 patients treated with ECPR for refractory cardiac arrest. The mean age of our patients was 61 years. Out-of-hospital cardiac arrest (OHCA) occurred in 33 patients, 26 patients suffered from in-hospital arrest (IHCA). Baseline value of lactate was 11.57±4.22 mmol/l, initial pH 6.95±0.31. In comparison with survivors, patients who died had significantly higher initial lactate levels (12.05±0.81 vs. 8.01±0.77; P<0.05). Moreover, survivors had significantly lower lactate levels after 24 hours (7.39 vs 2.56) and lower BMI (27.4 vs 31.2; P<0.05). Diabetes or hypertension in our group have no influence on the mortality. The difference of mortality in the group of OHCA or IHCA was also not significant. 32% patients survived one month with good neurological outcome (CPC 1–2), 30% six months, 23% one year and 21% two years. Conclusions ECPR give the last chance to survive refractory cardiac arrest. The levels of blood lactate are significantly associated with clinical outcomes of ECPR. Obesity was associated with significantly higher mortality in our group. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): MH CZ DRO (Nemocnice Na Homolce - NNH, 00023884)

Download Full-text

Abstract 117: Critical Care Management, Hospital Case Volume, and Survival After Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.117 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Joseph Tonna ◽

Craig Selzman ◽

Jason Bartos ◽

Angela Presson ◽

Yeonjung Jo ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support ◽

Coronary Intervention ◽

Left Ventricular ◽

Case Volume ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Clinical Variables ◽

Hospital Case

Introduction: For patients who receive extracorporeal cardiopulmonary resuscitation (ECPR), the relationship between post-resuscitation management and survival is unknown. Additionally, it is not known if management varies between centers, and if this variation and hospital case volume, are associated with survival. Hypothesis: There is center level variability in post-resuscitation management for ECPR patients. This variability, and hospital annual case volume, are associated with survival. Methods: We performed an observational study of 4,296 adults who received ECPR from the Extracorporeal Life Support Organization registry from 2014 until 2019. We examined clinical variables within the first 24 hours after arrest, and hospital annual ECPR volume. The primary outcome was case-mix adjusted survival at hospital discharge, adjusting for factors previously associated with survival after cardiac arrest or extracorporeal membrane oxygenation (ECMO). Mixed effects regression models were used to account for clustering of outcomes by center. Case volume was stratified into low (<6 cases/year), medium (6-12 cases/year) and high (>12 cases/year). Results: Patient-level clinical variables after cardiac arrest, varied widely across individual hospitals, including the use of percutaneous coronary intervention (PCI), mechanical venting of the left ventricle, and the use of inotropic medications. Increased ECMO circuit blood flow at 4 hours was associated with survival (OR 1.14 per liter per minute of flow [95% CI 1.04 to 1.24];p=0.004). After 24 hours of ECMO, increased arterial pulsatility (OR 1.44 [95% CI 1.32 to 1.58]; p<0.001), the placement of a distal perfusion catheter (OR 1.79 [95% CI 1.19 to 2.67]; p=0.005), and the placement of a mechanical left ventricular vent (OR 1.37 [95% CI 1.07 to 1.76]; p=0.012) were all significantly associated with survival. There was a nonsignificant association of the use of PCI after ECMO cannulation with survival (OR 1.31 [95% CI 0.998 to 1.91]; p=0.051). High case volume was not associated with survival (OR 1.32 [95% CI 0.98 to 1.78];p=0.072). Conclusions: Clinical management of ECPR patients varies across hospitals. These clinical variables and therapies are associated with survival, however center volume is not.

Download Full-text

Successful extracorporeal life support in cardiac arrest with recurrent ventricular fibrillation unresponsive to standard cardiopulmonary resuscitation

Resuscitation ◽

10.1016/j.resuscitation.2006.09.011 ◽

2007 ◽

Vol 73 (2) ◽

pp. 309-313 ◽

Cited By ~ 22

Author(s):

Jae-Seung Shin ◽

Sung-Woo Lee ◽

Gap-Su Han ◽

Won-Min Jo ◽

Sung-Hyuk Choi ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Extracorporeal Life Support

Download Full-text

Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2282-6 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Melanie Kuhnke ◽

Roland Albrecht ◽

Joerg C. Schefold ◽

Peter Paal

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Core Temperature ◽

Life Support ◽

Extracorporeal Life Support ◽

Weather Conditions ◽

Successful Resuscitation ◽

Case Presentation ◽

Favorable Neurological Outcome ◽

Level 1 Trauma Center

Abstract Background We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. Case presentation A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery. Conclusions Successful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available.

Download Full-text