scholarly journals Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

2016 ◽  
Vol 2 (4) ◽  
pp. 164-174 ◽  
Author(s):  
Theodora Benedek ◽  
Monica Marton Popovici ◽  
Dietmar Glogar
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Systems Of Care ◽  
Extracorporeal Life Support ◽  
Coronary Revascularization ◽  
Critical Approach ◽  
Extracorporeal Cardiopulmonary Resuscitation

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.

Impact of ventricular assistance devices on patients submitted to heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Perez-Ortega ◽  
J Prats ◽  
E Querol
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiopulmonary Resuscitation ◽  
Heart Transplant ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Terminal Heart Failure ◽  
One Year ◽  
Ventricular Assistance

Abstract Background The introduction of veno-arterial extracorporeal life support (v-a ECLS) widens the spectrum of patients that can be included in the heart transplant program, some examples are extended myocardial infarction, fulminant myocarditis or advanced cardiac insufficiency. In addition to this, the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) extends even more the range of patients that can be benefitted of this therapy as a bridge to transplant. Purpose Our objective is to describe the incidence of v-a ECLS in those patients submitted to a heart transplant and to establish whether or not this technique increases the risk of mortality in this population. Methods Retrospective and descriptive statistical analysis of 82 consecutive patients submitted to heart transplant between 2015 and 2019 in a High Technology University Hospital. Demographic and clinical data, extracorporeal life support, extracorporeal cardiopulmonary resuscitation and assistance device type, together with survival at 30 days and one year were collected. Results 82 patients were transplanted during the study period distributed as follows: 47 (51.69%) were elective and 35 (48.1%) emergent being 25 (30.12%) of grade 1A and 10 (12.19%) of grade 1B. 52% had prior intra-aortic balloon contrapulsation. Patients transplanted under ECLS were 80% men and average age of 53 (SD 15) years old. The most prevalent diagnosis was acute myocardial infarction Killip IV (32%), followed by terminal heart failure (28%). 32% of the patients were under peripheral ECMO, 36% under left ventricular assistance, 20% under biventricular assist device, and 12% required ECPR. 72% of devices were implanted in the operating room and 16% in the ICU. The one-year survival of the sample was 88%. 2 patients died after transplantation (8%) during the first month, and 1 patient died within the first year. All three patients had terminal heart failure and the VAD implant was inserted electively Conclusions ECLS prior to cardiac transplantation allow selected patients to arrive alive to the transplant. The choice among devices is related to the diagnosis and expected duration of the therapy but we have not found in our series effects on subsequent mortality. Survival at one year in the subjects analysed is greater than the national registry of the last 10 years, although the tendency is to improve every year. This new scenario implies an increment of the complexity in the management of these patients and requires an special effort in terms of staff ratio and training. In our centre, the implementation of ECLS resulted in an increment of our staff and formative sessions. Funding Acknowledgement Type of funding source: None

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

Perfusion ◽  
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.

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

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)

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

Circulation ◽  
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.

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.

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.

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.

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