scholarly journals Lactate Clearance Predicts Good Neurological Outcomes in Cardiac Arrest Patients Treated with Extracorporeal Cardiopulmonary Resuscitation

2019 ◽  
Vol 8 (3) ◽  
pp. 374 ◽  
Author(s):  
Christian Jung ◽  
Sandra Bueter ◽  
Bernhard Wernly ◽  
Maryna Masyuk ◽  
Diyar Saeed ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cox Regression ◽  
Lactate Concentration ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Baseline Characteristics ◽  
The Impact

Background: We evaluated critically ill patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) due to cardiac arrest (CA) with respect to baseline characteristics and laboratory assessments, including lactate and lactate clearance for prognostic relevance. Methods: The primary endpoint was 30-day mortality. The impact on 30-day mortality was assessed by uni- and multivariable Cox regression analyses. Neurological outcome assessed by Glasgow Outcome Scale (GOS) was pooled into two groups: scores of 1–3 (bad GOS score) and scores of 4–5 (good GOS score). Results: A total of 93 patients were included in the study. Serum lactate concentration (hazard ratio (HR) 1.09; 95% confidence interval (CI) 1.04–1.13; p < 0.001), hemoglobin, (Hb; HR 0.87; 95% CI 0.79–0.96; p = 0.004), and catecholamine use were associated with 30-day-mortality. In a multivariable model, only lactate clearance (after 6 h; OR 0.97; 95% CI 0.94–0.997; p = 0.03) was associated with a good GOS score. The optimal cut-off of lactate clearance at 6 h for the prediction of a bad GOS score was at ≤13%. Patients with a lactate clearance at 6 h ≤13% evidenced higher rates of bad GOS scores (97% vs. 73%; p = 0.01). Conclusions: Whereas lactate clearance does not predict mortality, it was the sole predictor of good neurological outcomes and might therefore guide clinicians when to stop ECPR.

Abstract 312: The Impact of Sedation on Quantitative Electroencephalogram Trends and Neurological Outcomes in a Mouse Model of Cardiac Arrest and Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Takamitsu Ikeda ◽  
Yusuke Miyazaki ◽  
Eizo Marutani ◽  
Fumito Ichinose
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Function ◽  
Temperature Management ◽  
Vehicle Group ◽  
Altered Level ◽  
Eeg Activity ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
The Impact

Introduction: The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although most CA survivors are sedated during targeted temperature management, the effects of sedation on post-arrest outcomes remain to be determined. Hypothesis: Sedation after CA improves neurological outcomes by modulating cerebral electrical activity and metabolism. Methods: Ten to 14 days after implantation of EEG transmitters, adult male C57BL/6J mice were subjected to CA and cardiopulmonary resuscitation (CPR). After return of spontaneous circulation (ROSC), mice received intravenous infusion of propofol, dexmedetomidine (DEX), or normal saline (vehicle) for 2 hours. Body temperature was maintained at 37°C, and was subsequently lowered to 33°C. Cerebral blood flow (CBF) was measured for 4 hours following ROSC. To quantify time-dependent EEG changes, we calculated the sum of the Delta, Theta, and Alpha band power in consecutive 12-hour intervals after ROSC (D 0-12 and D 12-24 , T 0-12 and T 12-24 , and A 0-12 and A 12-24 , respectively). Because the increase in fast EEG activity over time may reflect neurological recovery after CA, we compared the ratios of D 12-24 to D 0-12 , of T 12-24 to T 0-12 , and of A 12-24 to A 0-12 among groups. Results: As compared with vehicle-treated mice, propofol- or DEX-treated mice exhibited improved survival rate and neurological function after CA, though no difference was found between propofol- and DEX-treated mice. In the vehicle group, CBF was higher than the baseline after ROSC, while the increase in CBF was attenuated in the propofol and DEX group. The values of A 12-24 /A 0-12 and T 12-24 /T 0-12 were significantly higher in propofol- and DEX-treated mice than in vehicle-treated mice ( P = 0.017 and P = 0.004, respectively, propofol vs vehicle; P = 0.038 and P = 0.002, respectively, DEX vs vehicle), but there was no significant difference in D 12-24 /D 0-12 among groups. In all post-arrest mice, both A 12-24 /A 0-12 and T 12-24 /T 0-12 were positively correlated with better neurological function at 24 and 48 hours after CA. Conclusions: Post-arrest sedation was associated with a reduction in CBF and a greater recovery of fast EEG activity after CA, and improved neurological outcomes and survival in mice.

Abstract 265: Extracorporeal Cardiopulmonary Resuscitation for Acute Aortic Dissection During Cardiac Arrest: A Nationwide Retrospective Observational Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Takayuki Ogura ◽  
Hiroyuki Ohbe ◽  
Hideo Yasunaga
Keyword(s):  
Cardiac Arrest ◽  
Cost Effectiveness ◽  
Cardiopulmonary Resuscitation ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes

Aim: Acute aortic dissection has been considered a contraindication for extracorporeal cardiopulmonary resuscitation (ECPR). However, studies are lacking regarding the epidemiology and effectiveness of ECPR for this condition. We aimed to examine whether ECPR for acute aortic dissection during cardiac arrest is effective or not. Methods: Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified all emergently hospitalized adults who received ECPR on the day of admission. ECPR was defined as receiving both chest compressions and percutaneous extracorporeal membrane oxygenation on the day of hospital admission. In-hospital mortality and neurological outcomes were compared between patients with and without acute aortic dissection. We also calculated the incremental cost-effectiveness ratio of ECPR for acute aortic dissection. Results: We identified 10,238 patients who received ECPR on the day of admission. Of these, 398 patients (3.9%) had acute aortic dissection. In-hospital mortality was 98% in the acute aortic dissection group and 79% in the non-acute aortic dissection group. Seven patients (1.8%) in the acute aortic dissection group survived to discharge after ECPR; of these, six patients had good neurological outcomes at discharge. The incremental cost-effectiveness ratio of ECPR for patients with acute aortic dissection was estimated at 159,337 US dollars per quality-adjusted life year gained. Conclusion: ECPR successfully rescued a small number of acute aortic dissection patients with cardiac arrest; however, the cost burden of ECPR for acute aortic dissection patients was unacceptably high.

scholarly journals Impact of Cardiopulmonary Resuscitation Duration on the Neurological Outcomes of Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
HISSAH ALBINALI ◽  
Arwa Alumran ◽  
Saja AlRayes
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Bivariate Analysis ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Secondary Hospital ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background: Patients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative neurological outcomes. Cardiopulmonary resuscitation duration affects neurological outcomes of such patients, which suggests that duration of CPR may be vital to patient outcomes.Objectives: The study aims to evaluate the impact of cardiopulmonary resuscitation duration on neurological outcome of patients who have suffered out-of-hospital cardiac arrest.Methods: Data were collected from emergency cases handled by a secondary hospital in industrial Jubail, Saudi Arabia, between 2015 and 2020. There were 257 out-of-hospital cardiac arrest cases, 236 of which resulted in death.Results: Bivariate analysis showed no significant association between cerebral performance category (CPC) outcomes and duration of CPR, gender and cause of death whereas there is statistically significant between CPC and age. (p = 0.001). However, a good CPC outcome was reported with a (mean) limited duration of 8.1 min of CPR; whereas, poor CPC outcomes were associated with prolonged periods of CPR, 13.2 min (mean). Similarly, youthfulness was associated with good CPC outcomes as revealed by the mean age of 5.8 years, whereas a mean rank of 14.9 years was aligned with a poor CPC outcome.Conclusion: Cardiopulmonary Resuscitation Duration out-of-hospital cardiac arrest does not significantly influence the patient neurological outcome in the current study hospital. Other variables may have a more significant effect.

scholarly journals Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital cardiac arrest

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Akiko Higashi ◽  
Taka-aki Nakada ◽  
Taro Imaeda ◽  
Ryuzo Abe ◽  
Koichiro Shinozaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Quality Improvement ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Flow Duration ◽  
Over Time

Abstract Introduction Quality improvement in the administration of extracorporeal cardiopulmonary resuscitation (ECPR) over time and its association with low-flow duration (LFD) and outcomes of cardiac arrest (CA) have been insufficiently investigated. In this study, we hypothesized that quality improvement in efforts to shorten the duration of initiating ECPR had decreased LFD over the last 15 years of experience at an academic tertiary care hospital, which in turn improved the outcomes of in-hospital CA (IHCA). Methods This was a single-center retrospective observational study of ECPR patients between January 2003 and December 2017. A rapid response system (RRS) and an extracorporeal membrane oxygenation (ECMO) program were initiated in 2011 and 2013. First, the association of LFD per minute with the 90-day mortality and neurological outcome was analyzed using multiple logistic regression analysis. Then, the temporal changes in LFD were investigated. Results Of 175 study subjects who received ECPR, 117 had IHCA. In the multivariate logistic regression, IHCA patients with shorter LFD experienced significantly increased 90-day survival and favorable neurological outcomes (LFD per minute, 90-day survival: odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.94–1.00, P = 0.032; 90-day favorable neurological outcome: OR = 0.97, 95% CI = 0.94–1.00, P = 0.049). In the study period, LFD significantly decreased over time (slope − 5.39 [min/3 years], P < 0.0001). Conclusion A shorter LFD was associated with increased 90-day survival and favorable neurological outcomes of IHCA patients who received ECPR. The quality improvement in administering ECPR over time, including the RRS program and the ECMO program, appeared to ameliorate clinical outcomes.

scholarly journals Prognostic Value of Early Intermittent Electroencephalography in Patients after Extracorporeal Cardiopulmonary Resuscitation

2020 ◽  
Vol 9 (6) ◽  
pp. 1745 ◽  
Author(s):  
Yong Oh Kim ◽  
Ryoung-Eun Ko ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
Taek Kyu Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Neurological Status ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Neurological Prognosis

The aim of this study was to investigate whether early intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). This was a retrospective and observational study of adult patients who were evaluated by EEG scan within 96 h after ECPR. The primary endpoint was neurological status upon discharge from the hospital assessed with a Cerebral Performance Categories (CPC) scale. Among 69 adult cardiac arrest patients who underwent ECPR, 17 (24.6%) patients had favorable neurological outcomes (CPC score of 1 or 2). Malignant EEG patterns were more common in patients with poor neurological outcomes (CPC score of 3, 4 or 5) than in patients with favorable neurological outcomes (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcomes. In multivariable analysis, malignant EEG patterns and duration of cardiopulmonary resuscitation were significantly associated with poor neurological outcomes. In this study, malignant EEG patterns within 96 h after cardiac arrest were significantly associated with poor neurological outcomes. Therefore, an early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

2015 ◽  
Vol 35 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Jennie Ryan
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Survival Rates ◽  
Underlying Disease ◽  
The Body ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
The Impact

Extracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With venoarterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient’s caregivers. Offering support and guidance to the patient’s family as well as the patient is essential.

scholarly journals Association Between Neurological Outcomes and Extreme Hyperoxia in Patients with Out-of-Hospital Cardiac Arrest Who Underwent Extracorporeal Cardiopulmonary Resuscitation: A Retrospective Observational Study from a Multicenter Registry

2021 ◽  
Author(s):  
Masahiro Kashiura ◽  
Hideto Yasuda ◽  
Yuki Kishihara ◽  
Keiichiro Tominaga ◽  
Masaaki Nishihara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Analysis Model ◽  
Neurological Outcomes ◽  
Arterial Blood ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background: To investigate the impact of hyperoxia that developed immediately after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR) on patients’ 30-day neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This study retrospectively analyzed data from the Japanese OHCA registry from June 2014 to December 2017. We analyzed adult patients (18 years or older) who had undergone ECPR. Eligible patients were divided into the following three groups based on their initial partial pressure of oxygen in arterial blood (PaO2) levels after ECMO pump-on: normoxia group, PaO2 ≤ 200 mm Hg; moderate hyperoxia group, 200 mm Hg < PaO2 ≤ 400 mm Hg; and extreme hyperoxia group, PaO2 > 400 mm Hg. The primary and secondary outcomes were 30-day favorable neurological outcomes. Logistic regression statistical analysis model of 30-day favorable neurological outcomes was performed after adjusting for multiple propensity scores calculated using pre-ECPR covariates and for confounding factors post-ECPR.Results: Of the 34 754 patients with OHCA enrolled in the registry, 847 were included. The median PaO2 level was 300 mm Hg (interquartile range: 148–427 mm Hg). Among the eligible patients, 277, 313, and 257 were categorized as normoxic, moderately hyperoxic, and extremely hyperoxic, respectively. Moderate hyperoxia was not significantly associated with neurologically favorable outcomes compared with normoxia as a reference (adjusted odds ratio, 0.86; 95% confidence interval: 0.55–1.35; p = 0.51). However, extreme hyperoxia was associated with less neurologically favorable outcomes when compared with normoxia (adjusted odds ratio, 0.48; 95% confidence interval: 0.29–0.82; p = 0.007).Conclusions: For patients with OHCA who received ECPR, extreme hyperoxia (PaO2 > 400 mm Hg) was associated with poor neurological outcomes. Avoidance of extreme hyperoxia may improve neurological outcomes in patients with OHCA treated with ECPR.

Sign in / Sign up

Export Citation Format

Share Document