Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest According to Cannulation Sites: Cath Lab vs Non-Cath Lab

Background: In Japan, extracorporeal cardiopulmonary resuscitation (ECPR) became popular for cardiac arrest patients who resist conventional advanced life supports. Regardless of many clinical experiences, there has been no previous systematic literature review. Methods: Case series, reports and proceedings of scientific meeting about ECPR for out-of-hospital cardiac arrest written in Japanese between January 1, 1983 and July 31, 2007 were collected with Japana Centra Revuo Medicina (medical publication database in Japan) and review by experts. The outcome and characteristics of the patients were investigated, and the influence of publication bias of the case series study was also examined by the Funnel Plot method. Results: There were 951 out-of-hospital cardiac arrest patients who received ECPR in 92 reports (including 59 case series and 33 case reports) during the period. The average of age was 38.1 (4 – 88) years old and 76.1% was male. Three hundreds and eighty-one cases (40.1%) were arrests of cardiac etiology, and 212 were non-cardiac (22.3%). The cause of arrest was not described in other 37.6%. Excluding reports for only one case, weighted survival rate at discharge of 792 cases those were clearly described the outcome was 39.5±10.0%. When the relationship between the number of cases and the survival rate at discharge in each 59 case series study was shown in figure by the Funnel Plot method, the plotted data presented the reverse-funnel type that centered on the average of survival rate of all. Conclusions: The influence of publication bias of previous reports in Japan was relatively low. ECPR can greatly contribute to improve the outcome of out-of hospital cardiac arrests.

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In-hospital extracorporeal cardiopulmonary resuscitation (ECPR) after prolonged out-of-hospital cardiac arrest (OHCA). A case report

Resuscitation ◽

10.1016/j.resuscitation.2018.07.085 ◽

2018 ◽

Vol 130 ◽

pp. e48-e49

Author(s):

Antonella Vezzani ◽

Tullio Manca ◽

Andrea Ramelli ◽

Bruno Borrello ◽

Andrea Agostinelli ◽

...

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

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

Scientific Reports ◽

10.1038/s41598-020-79283-1 ◽

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.

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Treatment of a patient with acute aortic dissection using extracorporeal cardiopulmonary resuscitation after an out-of-hospital cardiac arrest: a case report

Acute Medicine & Surgery ◽

10.1002/ams2.324 ◽

2017 ◽

Vol 5 (2) ◽

pp. 189-193 ◽

Cited By ~ 8

Author(s):

Takahiro Yukawa ◽

Kazuhiro Sugiyama ◽

Kazuki Miyazaki ◽

Takahiro Tanabe ◽

Susumu Ishikawa ◽

...

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Cardiopulmonary Resuscitation ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

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Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – A comparison with that for extracorporeal rescue for in-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2014.06.022 ◽

2014 ◽

Vol 85 (9) ◽

pp. 1219-1224 ◽

Cited By ~ 123

Author(s):

Chih-Hsien Wang ◽

Nai-Kuan Chou ◽

Lance B. Becker ◽

Jou-Wei Lin ◽

Hsi-Yu Yu ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest ◽

Improved Outcome

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Caution when defining prolonged downtime in out of hospital cardiac arrest as extracorporeal cardiopulmonary resuscitation becomes accessible and feasible

Resuscitation ◽

10.1016/j.resuscitation.2014.05.018 ◽

2014 ◽

Vol 85 (8) ◽

pp. 979-980 ◽

Cited By ~ 10

Author(s):

Kelly N. Sawyer ◽

Michael C. Kurz

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

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Refractory out-of-hospital cardiac arrest with ongoing cardiopulmonary resuscitation at hospital arrival – survival and neurological outcome without extracorporeal cardiopulmonary resuscitation

Critical Care ◽

10.1186/s13054-018-2176-9 ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 11

Author(s):

Emilie Gregers ◽

Jesper Kjærgaard ◽

Freddy Lippert ◽

Jakob H. Thomsen ◽

Lars Køber ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Arrival ◽

Hospital Cardiac Arrest

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Abstract 588: Extracorporeal Cardiopulmonary Resuscitation for Induction of Hypothermia in Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_585-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ken Nagao ◽

Kimio Kikushima ◽

Kazuhiro Watanabe ◽

Eizo Tachibana ◽

Takaeo Mukouyama ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Control Group ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hypothermia Group ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Therapeutic hypothermia is beneficial to neurological outcome for comatose survivors after out-of-hospital cardiac arrest. However, there are few data of extracorporeal cardiopulmonary resuscitation (ECPR) for induction of hypothermia for patients with out-of-hospital cardiac arrest. We did a prospective study of ECPR with hypothermia for patients with out-of-hospital cardiac arrest. The criteria for inclusion were an age of 18 to 74 years, a witnessed cardiac arrest, collapse-to-patient’s-side interval <15 minutes, cardiac arrest due to presumed cardiac etiology, and persistent cardiac arrest on ER arrival in spite of the prehospital defibrillations. After arrival at the emergency room, cardiopulmonary bypass plus intra-aortic balloon pumping was immediately performed, and then coronary reperfusion therapy during cardiac arrest was added if needed. Mild hypothermia (34°C for 3 days) was immediately induced during cardiac arrest or after return of spontaneous circulation. We selected suitable patients who received conventional CPR with normothermia among a prospective multi-center observational study of patients who had out-of-hospital cardiac arrest in Kanto region of Japan “the SOS-KANTO study” for the control group. The primary endpoint was favorable neurological outcome at the time of hospital discharge. A total of 558 patients were enrolled; 127 received ECPR with hypothermia and 431 received conventional CPR with normothermia. The ECPR with hypothermia group had significantly higher frequency of the favorable neurological outcome than the conventional CPR with normothermia group (12% vs. 2%, unadjusted odds ratio, 8.1; 95% CI; 3.2 to 20.0). The adjusted odds ratio for the favorable neurological outcome after ECPR with hypothermia was 7.4 (95% CI; 2.8 to 19.3, p<0.0001). Among the ECPR with hypothermia group, early attainment of a target core temperature of 34°C increased its efficacy (adjusted odds ratio, 0.99; 95% CI; 0.98 to 1.00, p=0.04). ECPR with hypothermia improved the chance of neurologically intact survival for adult patients with out-of-hospital cardiac arrest, and the early attainment of a target temperature enhanced its efficacy.

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