scholarly journals Initial Arterial pCO2 and its Course in the First Hours of Extracorporeal Cardiopulmonary Resuscitation Show No Association with Recovery of Consciousness in Humans: A Single-Centre Retrospective Study

Membranes ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 208
Author(s):  
Loes Mandigers ◽  
Corstiaan A. den Uil ◽  
Jeroen J. H. Bunge ◽  
Diederik Gommers ◽  
Dinis dos Reis Miranda
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Carbon Dioxide Concentration ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Severe Condition ◽  
Arterial Pco2 ◽  
Maximum Decrease ◽  
Rate Of Recovery ◽  
Recovery Of Consciousness

Background: Cardiac arrest is a severe condition with high mortality rates, especially in the case of prolonged low-flow durations resulting in severe ischaemia and reperfusion injury. Changes in partial carbon dioxide concentration (pCO2) may aggravate this injury. Extracorporeal cardiopulmonary resuscitation (ECPR) shortens the low-flow duration and enables close regulation of pCO2. We examined whether pCO2 is associated with recovery of consciousness. Methods: We retrospectively analysed ECPR patients ≥ 16 years old treated between 2010 and 2019. We evaluated initial arterial pCO2 and the course of pCO2 ≤ 6 h after initiation of ECPR. The primary outcome was the rate of recovery of consciousness, defined as Glasgow coma scale motor score of six. Results: Out of 99 ECPR patients, 84 patients were eligible for this study. The mean age was 47 years, 63% were male, 93% had a witnessed arrest, 45% had an out-of-hospital cardiac arrest, and 38% had a recovery of consciousness. Neither initial pCO2 (Odds Ratio (OR) 0.93, 95% confidence interval 95% (CI) 0.78–1.08) nor maximum decrease of pCO2 (OR 1.03, 95% CI 0.95–1.13) was associated with the recovery of consciousness. Conclusion: Initial arterial pCO2 and the course of pCO2 in the first six hours after initiation of ECPR were not associated with the recovery of consciousness.

scholarly journals Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yo Sep Shin ◽  
Youn-Jung Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
Shin Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Status ◽  
Good Neurologic Outcome ◽  
Hospital Stays ◽  
Hospital Cardiac Arrest

AbstractPrecise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

2020 ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

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 Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

Abstract 11336: Experience with an Institutional Guideline on Extracorporeal Cardiopulmonary Resuscitation for Refractory in Hospital and Out of Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Marie Oebo ◽  
Nils Lars Olof Lundgren ◽  
Sarah Maiken Delaïre ◽  
Helle Laugesen ◽  
Jan J Andreasen
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Flow Time ◽  
Low Flow ◽  
Exclusion Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Before And After ◽  
Improvement In Survival ◽  
Refractory Cardiac Arrest

Aim: To compare survival rates in patients with refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an action card.The primary outcome was survival to discharge, and secondary outcomes were low-flow time and rate of cerebral complications. Methods: Retrospective evaluation of 37 patients treated with ECPR for refractory cardiac arrest. Information was obtained through medical records. Patients were categorized into two groups - before (BA) and after (AA) introduction of an action card. The card entailed inclusion and exclusion criteria used to evaluate the benefit of ECPR for any individual patient. Results: There were no statistically significant differences in baseline characteristics between the groups.After the introduction of the action card, survival to discharge increased from 6.7 % to 18.2 % suggesting a trend toward improved survival, despite this finding being statistically insignificant (p = 0.629).Low-flow time was reduced from 100 (12-195) minutes to 66 (30-195) minutes and the upper extreme was reduced from 195 to 153 minutes, but this was not statistically significant (p = 0.334).Cerebral factors contributed to significantly fewer deaths in AA compared with BA (p = 0.0022). Conclusion: There was no statistically significant improvement in survival rates nor a reduction in low-flow time after the implementation of an action card for the use of ECPR in patients with refractory CA. However, cerebral causes factored in fewer deaths and several patients survived despite meeting potential exclusion criteria outlined in local and international guidelines.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

2020 ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome.Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology.Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

Abstract 362: Early Signs of Life as a Prognostic Factor for Extracorporeal Cardiopulmonary Resuscitation in Refractory Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Guillaume Debaty ◽  
Mathilde Nicol ◽  
Romain Aubert ◽  
Cyriel Clape ◽  
Pierre Bouzat ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Pupillary Response ◽  
Favorable Outcome ◽  
Neurologic Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Multicenter Observational Study ◽  
Flow Duration ◽  
Early Signs

Introduction: After 20 to 30 minutes of cardiopulmonary resuscitation (CPR) without return of spontaneous circulation (ROSC), cardiac arrest is considered as refractory (RCA). For RCA, extracorporeal CPR (ECPR) is one of the only treatments with a potential benefit on survival. Presence of gasping during CPR has been shown to be strongly associated with a favorable outcome. To our knowledge, signs of life during CPR (such as gasping, movements, pupillary response) has not been studied in the specific context of RCA treated with ECPR. Hypothesis: We assessed the relationship between survival with favorable neurologic outcomes and presence of early signs of life during or before CPR in RCA treated with ECPR. Methods: We carried out a multicenter observational study of patients with out-of-hospital RCA treated with ECPR in 3 cities in France. Primary outcome was favorable neurologic outcome at 30 days defined as CPC score ≤ 2. Signs of life were defined as gasping or recovery of normal breathing, any pupillary response or any movements during CPR. Patient selection for ECPR was decided according to french guidelines criteria such as initial rhythm, no-flow duration, expected transport time and EtCO2 > 10 mmHg. A logistic regression analysis was performed. P -values < 0.05 were considered statistically significant. Results: Overall, 437 patients treated with ECPR were included with 71 (16%) patients with CPC ≤ 2 at 30 days. Signs of life were observed in 261 (59%) patients, with 136 (31%) patients presenting gasping or respiratory movement, 155 (35%) a pupillary response, and 49 (11%) movements during CPR. Overall 63/261 (24.1%) patients with signs life survived with favorable neurologic outcome vs. 8/176 (4.5%) without signs of life, p<0.0001. In multivariate analysis, factors associated with favorable outcome were: signs of life during CPR (OR 11.0, 95%CI 3.7-32.5; p<0.001), first recorded rhythm VF/VT (OR 3.4, 95%CI 1.3-8.9; P=0.011), low-flow duration per min (OR 0.99, 95%CI 0.98-1.00; p=0.032). Conclusions: These results highlight the importance of signs of life before or during CPR on neurological outcomes for RCA treated with ECPR. These results could help select patients with good chance of survival in whom we should not give up resuscitation efforts too soon.

scholarly journals Reliability of prognostic biomarkers after prehospital extracorporeal cardiopulmonary resuscitation with target temperature management

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Walter Petermichl ◽  
Alois Philipp ◽  
Karl-Anton Hiller ◽  
Maik Foltan ◽  
Bernhard Floerchinger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Flow Time ◽  
Low Flow ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) performed at the emergency scene in out-of-hospital cardiac arrest (OHCA) can minimize low-flow time. Target temperature management (TTM) after cardiac arrest can improve neurological outcome. A combination of ECPR and TTM, both implemented as soon as possible on scene, appears to have promising results in OHCA. To date, it is still unknown whether the implementation of TTM and ECPR on scene affects the time course and value of neurological biomarkers. Methods 69 ECPR patients were examined in this study. Blood samples were collected between 1 and 72 h after ECPR and analyzed for S100, neuron-specific enolase (NSE), lactate, D-dimers and interleukin 6 (IL6). Cerebral performance category (CPC) scores were used to assess neurological outcome after ECPR upon hospital discharge. Resuscitation data were extracted from the Regensburg extracorporeal membrane oxygenation database and all data were analyzed by a statistician. The data were analyzed using non-parametric methods. Diagnostic accuracy of biomarkers was determined by area under the curve (AUC) analysis. Results were compared to the relevant literature. Results Non-hypoxic origin of cardiac arrest, manual chest compression until ECPR, a short low-flow time until ECPR initiation, low body mass index (BMI) and only a minimal need of extra-corporeal membrane oxygenation support were associated with a good neurological outcome after ECPR. Survivors with good neurological outcome had significantly lower lactate, IL6, D-dimer, and NSE values and demonstrated a rapid decrease in the initial S100 value compared to non-survivors. Conclusions A short low-flow time until ECPR initiation is important for a good neurological outcome. Hypoxia-induced cardiac arrest has a high mortality rate even when ECPR and TTM are performed at the emergency scene. ECPR patients with a higher BMI had a worse neurological outcome than patients with a normal BMI. The prognostic biomarkers S100, NSE, lactate, D-dimers and IL6 were reliable indicators of neurological outcome when ECPR and TTM were performed at the emergency scene.

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