scholarly journals Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Lars J. Bjertnæs ◽  
Kristian Hindberg ◽  
Torvind O. Næsheim ◽  
Evgeny V. Suborov ◽  
Eirik Reierth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Body Temperature ◽  
Hospital Discharge ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Meta Analysis ◽  
Low Ph ◽  
Individual Data ◽  
Male Sex

Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO).Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P < 0.05 considered significant.Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis.Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.

scholarly journals Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

2016 ◽  
Vol 42 (12) ◽  
pp. 1922-1934 ◽  
Author(s):  
Dagmar M. Ouweneel ◽  
Jasper V. Schotborgh ◽  
Jacqueline Limpens ◽  
Krischan D. Sjauw ◽  
A. E. Engström ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Meta Analysis

scholarly journals TCT-128 A systematic review and meta-analysis of extracorporeal life support during cardiac arrest and cardiogenic shock

2016 ◽  
Vol 68 (18) ◽  
pp. B52
Author(s):  
Dagmar M. Ouweneel ◽  
Jasper Schotborgh ◽  
Jaqueline Limpens ◽  
Krischan Sjauw ◽  
Annemarie Engstrom ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Meta Analysis

scholarly journals Survival of pediatric patients after cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Melaku Bimerew ◽  
Adam Wondmieneh ◽  
Getnet Gedefaw ◽  
Teshome Gebremeskel ◽  
Asmamaw Demis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Probability Of Survival ◽  
Pooled Prevalence ◽  
Hospital Cardiac Arrest

Abstract Background In-hospital cardiac arrest is a major public health issue. It is a serious condition; most probably end up with death within a few minutes even with corrective measures. However, cardiopulmonary resuscitation is expected to increase the probability of survival and prevent neurological disabilities in patients with cardiac arrest. Having a pooled prevalence of survival to hospital discharge after cardiopulmonary resuscitation is vital to develop strategies targeted to increase probability of survival among patients with cardiac arrest. Therefore, this systematic review and meta-analysis was aimed to assess the pooled prevalence of survival to hospital discharge among pediatric patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. Methods PubMed, Google Scholar, and Cochrane review databases were searched. To have current (five-year) evidence, only studies published in 2016 to 2020 were included. The weighted inverse variance random-effects model at 95%CI was used to estimate the pooled prevalence of survival. Heterogeneity assessment, test of publication bias, and subgroup analyses were also employed accordingly. Results Twenty-five articles with a total sample size of 28,479 children were included in the final analysis. The pooled prevalence of survival to hospital discharge was found to be 46% (95% CI = 43.0–50.0%; I2 = 96.7%; p < 0.001). Based on subgroup analysis by “continent” and “income level”, lowest prevalence of pooled survival was observed in Asia (six studies; pooled survival =36.0% with 95% CI = 19.01–52.15%; I2 = 97.4%; p < 0.001) and in low and middle income countries (six studies, pooled survival = 34.0% with 95% CI = 17.0–51.0%, I2 = 97.67%, p < 0.001) respectively. Conclusion Although there was an extremely high heterogeneity among reported results (I2 = 96.7%), in this meta-analysis more than half of pediatric patients (54%) who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest did not survived to hospital discharge. Therefore, developing further strategies and encouraging researches might be crucial.

scholarly journals The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5573
Author(s):  
Karol Bielski ◽  
Agnieszka Szarpak ◽  
Miłosz Jaroslaw Jaguszewski ◽  
Tomasz Kopiec ◽  
Jacek Smereka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Survival Outcomes ◽  
Cochrane Central Register ◽  
Mortality And Morbidity ◽  
Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review

2020 ◽  
Author(s):  
Paweł Podsiadło ◽  
Tomasz Darocha ◽  
Øyvind S. Svendsen ◽  
Sylweriusz Kosiński ◽  
Tom Silfvast ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support

scholarly journals Esmolol for the treatment of refractory ventricular fibrillation: a systematic review and meta-analysis

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Richard Armour ◽  
Leon Baranowski
Keyword(s):  
Systematic Review ◽  
Ventricular Fibrillation ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Life Support ◽  
Cardiopulmonary Arrest ◽  
Meta Analysis ◽  
Grey Literature ◽  
Neurological Status ◽  
Cochrane Library

<p><strong>Introduction: </strong>In light of recent research the efficacy of current advanced life support treatments has been questioned. Ventricular fibrillation refractory to standard therapy is a presentation which may benefit from an updated approach to management, with the b<sub>1</sub>-adrenoreceptor antagonist esmolol considered a therapy which may confer benefit. This systematic review and meta-analysis aimed to summarise the available evidence for esmolol in refractory ventricular fibrillation and identify if it may have any role in ACLS guidelines.</p><p><strong>Methods: </strong> The Cochrane Library, MEDLINE, CINAHL and EMBASE were systematically reviewed, along with trial registries and the grey literature. Studies were included in the review and subsequent meta-analysis if they examined adult patients in cardiopulmonary arrest with ventricular fibrillation refractory to at least three attempts at defibrillation and one dose of adrenaline or anti-arrhythmic therapy, who subsequently received intravenous esmolol.</p><p><strong>Results: </strong> 2,617 results were obtained with 12 full-text articles reviewed for inclusion. Ultimately, two unique results fulfilled the inclusion criteria. A total of 66 patients were included in the meta-analysis, of whom 22 received esmolol. Esmolol appears to improve to survival to hospital admission (RR 2.63, 95% CI 1.37-5.07, p=0.004), temporary (RR 2.34, 95% CI 1.09-5.02, p=0.03) and sustained ROSC (RR 2.63, 95% CI 1.37-5.07, p=0.004) and favourable neurological status at hospital discharge (RR 3.44, 95% CI 1.11-10.67, p=0.03). The use of esmolol also appeared to likely confer a benefit in survival to hospital discharge (RR 2.82, 95% CI 1.01-7.93, p=0.05). However, significant bias was observed across all outcomes and overall these results were considered to be of low to very low certainty.</p><p><strong>Conclusion: </strong>The use of esmolol in refractory ventricular fibrillation appears to improve survival to hospital admission, temporary and sustained ROSC and neurological status at hospital discharge, but not survival to hospital discharge. However, these results should be interpreted with caution in light of the limitations of included studies and the subsequent impact of these limitations on the outcomes included in the meta-analysis. Further high-quality, prospective research is required prior to recommending esmolol for use in refractory ventricular fibrillation.<strong></strong></p>

scholarly journals Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review

Perfusion ◽  
2020 ◽  
Vol 35 (1_suppl) ◽  
pp. 20-28 ◽  
Author(s):  
Matteo Matteucci ◽  
Mariusz Kowalewski ◽  
Dario Fina ◽  
Federica Jiritano ◽  
Paolo Meani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Meta Analysis ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction

Introduction: Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock. Extracorporeal life support, in veno-arterial mode, application in refractory acute heart dysfunction is sharply increasing worldwide. However, its clinical utility in phaeochromocytoma-induced cardiogenic shock remains still unclear. Methods: A systematic review of published reports was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Searches were accomplished on PubMed, Embase and Google Scholar to identify articles describing the use of extracorporeal life support in the setting of phaeochromocytoma-induced cardiogenic shock (PROSPERO: CRD42019125225). Results: Thirty-five reports, including 62 patients supported with extracorporeal life support because of intractable phaeochromocytoma crisis, were included for the analysis. Almost all the subjects underwent peripheral cannulation for extracorporeal life support. The median duration of the mechanical circulatory support was 5 days, and most of the patients recovered normal myocardial function (left ventricular ejection fraction ⩾50%). In-hospital survival was 87%. Phaeochromocytoma was removed surgically during extracorporeal life support in 10 patients (16%), while in the remaining after haemodynamic stabilization and weaning from the mechanical support. Conclusion: Successful management of phaeochromocytoma-induced cardiogenic shock depends on prompt recognition and immediate treatment of shock. In this scenario, extracorporeal life support may play a significant role allowing cardiac and end-organ recovery and giving time for accurate diagnosis and specific treatment.

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