Background The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications. Methods We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2. Results A total of 1644 patients with OHCA were included in this study. The patient age was 18–93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45–66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively. Conclusions In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.
BackgroundPosttraumatic pseudoaneurysms (PAs) have been recognized as the cause of delayed hemorrhage complicated with nonoperative management (NOM), although the need for intervention in patients with small-sized PAs and the relationship between the occurrence of PAs and bed-rest has been also unclear.ObjectivesThe purpose of this study was to investigate the clinical history of small-sized PAs (less than 10 mm in diameter) which occurred in abdominal solid organs, and to analyze the relationship between the occurrence of PAs and early mobilization from bed.MethodsSixty-two patients who were successfully managed with NOM were investigated. Mobilization within three days post-injury was defined as “early mobilization” and bed-rest lasting over three days was defined as “late mobilization.” A comparison of the clinical factors, including the duration of bed-rest between patients with and without PAs detected by follow-up CT was performed. Furthermore, a multiple logistic regression model analysis on the occurrence of PAs was performed.ResultsPAs were detected in 7 of the 62 patients. The One patient with PAs measuring larger than 10 mm received trans-arterial embolization, and the remaining six patients with PAs smaller than 10 mm were managed conservatively. Consequently, no delayed hemorrhage occurred, and the PAs spontaneously disappeared in all of the six patients managed without intervention. The multiple regression model analysis revealed that early mobilization was not a significant factor predicting new-onset PAs.ConclusionsSmall PAs can be expected to disappear spontaneously. Moreover, early mobilization is not a significant risk factor for the occurrence of PAs.
A lack of known guidelines for the provision of extracorporeal cardiopulmonary resuscitation (ECPR) to patients with out-ofhospital cardiac arrest (OHCA) has led to variability in practice between hospitals even in the same country. Because variability in ECPR practice has not been completely examined, we aimed to describe the variability in ECPR practice in patients with OHCA from the emergency department (ED) to the intensive care units (ICU).Methods: An anonymous online questionnaire to examine variability in ECPR practice was completed in January 2020 by 36 medical institutions who participated in the SAVE-J II study. Institutional demographics, inclusion and exclusion criteria, initial resuscitation management, extracorporeal membrane oxygenation (ECMO) initiation, initial ECMO management, intra-aortic balloon pumping/endotracheal intubation/management during coronary angiography, and computed tomography criteria were recorded. Results:We received responses from all 36 institutions. Four institutions (11.1%) had a hybrid emergency room. Cardiovascular surgery was always involved throughout the entire ECMO process in only 14.7% of institutions; 60% of institutions had formal inclusion criteria and 50% had formal exclusion criteria. In two-thirds of institutions, emergency physicians carried out cannulation. Catheterization room was the leading location of cannulation (48.6%) followed by ED (31.4%). The presence of formal exclusion criteria significantly increased with increasing ECPR volume (P for trend <0.001). Intra-aortic balloon pumping was routinely initiated in only 25% of institutions. Computed tomography was routinely carried out before coronary angiography in 25% of institutions. Conclusions:We described the variability in ECPR practice in patients with OHCA from the ED to the ICU.
Background Optimal sedation regimens for patients after extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This study compared the outcomes of patients who received propofol and midazolam for sedation post-ECPR for out-of-hospital cardiac arrest (OHCA). Methods A retrospective cohort study analysed data from the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan, including patients admitted to 36 intensive care units (ICU) in Japan post-ECPR for OHCA of cardiac aetiology between 2013 and 2018. One-to-one propensity score-matched analysis compared outcomes between patients post-ECPR for OHCA who received exclusive treatment with a continuous propofol infusion (propofol users) and those who received exclusive treatment with a continuous midazolam infusion (midazolam users). The cumulative incidence and competing risk methodology were used to compare the time to liberation from mechanical ventilation and ICU discharge. Results Propensity score-matching created 109 matched pairs of propofol and midazolam users with balanced baseline characteristics. Competing risk analysis for the 30-day ICU period showed no significant difference in the probability of liberation from mechanical ventilation (0.431 vs. 0.422, P = 0.882) and ICU discharge (0.477 vs. 0.440, P = 0.634). Furthermore, there was no significant difference in the proportion of 30-day survival (0.399 vs. 0.398, P = 0.999), 30-day favourable neurological outcome (0.176 vs. 0.185, P = 0.999), and vasopressor requirement within 24-h post-ICU admission (0.651 vs. 0.670, P = 0.784). Conclusions This multicentre cohort study revealed no significant differences in mechanical ventilation duration, ICU stay length, survival, neurological outcomes, and vasopressor requirement between propofol and midazolam users admitted to the ICU after ECPR for OHCA.
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