Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation

Chen, Yih-Sharng; Chao, Anne; Yu, Hsi‐Yu; Ko, Wen‐Je; Wu, I-Hui; Chen, Robert Jen-Chen; Huang, Shu‐Chien; Lin, Fang‐Yue; Wang, Shoei‐Shen

doi:10.1016/s0735-1097(02)02716-x

Cited by 330 publications

(227 citation statements)

References 28 publications

Supporting

Mentioning

213

Contrasting

Unclassified

Order By: Relevance

“…7) Because PCPS is a portable and powerful resuscitative tool, it has been effectively used for the treatment of cardiac failure in various situations such as postcardiotomy low output syndrome, 6,8) prolonged cardiopulmonary resuscitation, 9) and acute myocardial infarction. 10) Additionally, PCPS has been used prophylactically in high-risk coronary patients needing percutaneous stent revascularization.…”

Section: Discussionmentioning

confidence: 99%

Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

et al. 2006

View full text Add to dashboard Cite

SUMMARYThe percutaneous cardiopulmonary support system (PCPS) has been widely accepted for the treatment of patients with severe cardiac failure. This system, which uses Seldinger's method through a percutaneous approach, enables rapid application in emergency situations. However, the indication for deployment and discontinuation of PCPS has not yet been established. We evaluated the results of PCPS use for the treatment of patients with severe cardiac failure and investigated factors that would predict successful weaning from PCPS.A total of 32 patients (23 men and 9 women) who had PCPS for the treatment of severe cardiac failure between January 1997 and October 2004 were retrospectively reviewed. The mean age of the patients was 57 ± 17 years (range, 14 to 78 years). PCPS was necessary for severe cardiac failure after cardiac surgery in 15 patients, pulmonary infarction in 4, acute myocardial infarction in 3, acute myocarditis in 3, and other causes in 7.The mean duration of PCPS support in all 32 patients was 134 ± 117 hours (range, 8 to 532). Twelve patients (38%) could be weaned from PCPS (group A), while the remaining 20 patients (62%) could not (group B). The incidence of cardiac arrest prior to PCPS use (n = 10, 31%) was significantly (P < 0.05) lower in group A (1/12, 8%) than in group B (9/20, 45%). There were significant differences in the APACHE II scores, urine output, serum lactate levels, and epinephrine and dopamine dose received from PCPS induction to 72 hours after PCPS use between the 2 groups (P < 0.05). Multivariate logistic regression analysis showed that an episode of cardiac arrest prior to PCPS induction was the only significant predictor for the unsuitability for discontinuation of PCPS.This retrospective study showed the limitation of PCPS therapy for patients with an episode of cardiac arrest who did not show improvement in their APACHE II score, urine output, serum lactate levels, and catecholamine dose received within 72 hours after PCPS induction. These results may help formulate criteria for indication and discontinuation of From the

show abstract

Section: Discussionmentioning

confidence: 99%

Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

et al. 2006

View full text Add to dashboard Cite

show abstract

“…The tip of the arterial cannula is positioned in the common iliac artery and the venous cannula is positioned at the right atrium through the femoral artery and vein, respectively. The indications for ECMO were decided upon based on previous reports: 1) cardiac pump failure shown as systolic blood pressure < 80 mmHg, pulmonary capillary wedge pressure (PCWP) > 20 mmHg, cardiac index < 2.0 L/min/m 2 , regardless of receiving catecholamines and intra-aortic balloon pumping, 2) ventricular tachyarrythmia with hemodynamic collapse resistant for antiarrhythmic agents, [3][4][5][6] without preexisting severe neurological deficits. Patients were anesthetized with propofol and/or midazolam, and administered vecuronium bromide as a muscle relaxant as needed.…”

Section: Methodsmentioning

confidence: 99%

“…4) Balancing the invasiveness of LVAS implantation and subsequent clinical recovery under ECMO support, appropriate timing for switching from initial ECMO to LVAS must be considered. Although some reports have identified the factors correlated with ECMO weaning, 1,5) we must be aware of their limitations: clinical parameters with only 'statistically' significant differences during longstanding intervals, are not as 'clinically' sig- (1-7). The flexion points of ETCO 2 prior to ECMO weaning (E-point in Figure 1, solid triangle) were indicated by an initial increase in ETCO 2 of ≥ 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours.…”

Section: Clinical Implication Of Recovery Time Point Using Etcomentioning

confidence: 99%

End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

et al. 2010

View full text Add to dashboard Cite

SummaryAlthough extracorporeal membrane oxygenation (ECMO) is widely used as temporary circulation support, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning off.Twenty-five patients supported by ECMO due to hemodynamic deterioration were divided into 2 groups according to their outcome: weaned ECMO (W: n = 18) or not (NW: n = 7). In the W group, we examined the differences in parameters between the 2 time points, ECMO introduction, and the reduction in ECMO flow to 40% of the initial setting known as the conventional recovery point (C-point). Significant differences were observed in systolic pulmonary artery pressure, the cardiac index measured by the thermodilution method, C-reactive protein, lactate, base excess, and the end-tidal CO 2 concentration (ETCO 2 ). Next, by closely examining these 6 parameters measured every 12 hours, we found that only ETCO 2 had always changed steeply, like a 'flexion point' (E-point), in all W cases, but not in NW. The E-point was defined as an initial increase in ETCO 2 of ≥ 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours. E-points appeared as much as 95 ± 60 hours earlier than C-points and also preceded weaning off of ECMO.ETCO 2 can be a useful continuous parameter for predicting the adequate timing of weaning off of ECMO for circulatory failure at the bedside. (Int Heart J 2010; 51: 116-120) Key words: End-tidal carbon dioxide, Extracorporeal membrane oxygenation, Hemodynamic deterioration, Clinical predictor, Weaning E xtracorporeal membrane oxygenation (ECMO) is widely used not only for temporary cardiopulmonary support in cases of hemodynamic deterioration, but also in bridge therapy for left ventricular assist system (LVAS) as well as cardiac transplantation.1,2) Although setting up the equipment is easy, a quick overall methodology during management has not been fully established. There have been few guidelines concerning its utilization in relation to the treatment of fulminant myocarditis.3) The guidelines say, for example, that ECMO flow of 3-3.5 L/min initially should be reduced gradually with improved cardiac function to around 1.0 L/min, followed by weaning off. As for the predictive indicators, resultant ECMO flow fell to about 40% of the initial flow, implying cardiac recovery, and patients can subsequently be weaned off ECMO.3) Under conventional methodology using 'trial and error' as described above, however, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning patients off ECMO. In this study, we focused on clinical variables measured continuously at the patient's bedside, especially the end-tidal carbon dioxide concentration (ETCO 2 ), to determine the appropriate time to wean patients off ECMO. MethodsPatient population and clinical classification: Thirty-seven consecutive patients with cardiovascular disorders treated with ECMO at our institution between 1996-2008 were investigated. We excluded patients in whom ECMO wa...

show abstract

“…As a bridge to definitive therapy, ECMO has also been used in patients with cardiogenic shock from acute coronary syndromes and as a bridge to transplant with or without the use of other ventricular assist devices. Multiple reports of ECMO being instituted for cardiac arrest [102,103] exist, and the institution of ECMO for cardiovascular collapse and cardiac arrest is rapidly growing in popularity [104]. A major advantage is the relative ease of implementation, but a disadvantage is the need for specialized perfusion expertise and nursing.…”

Section: Extra-corporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino Americana de cardiologia intervencion; Affirmation of value by the canadian association of interventional cardiology–association canadienne de cardiologie d'intervention)

Rihal

Naidu

Givertz

et al. 2015

Cathet Cardio Intervent

View full text Add to dashboard Cite

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella V R ; left atrial to femoral artery bypass pumps, specifically the is approached by other guideline developers and asked to review and consider guidelines for endorsement. Guidelines developed by external organizations will be considered for affirmation of value. The CAIC may not agree with every recommendation in such a document, but overall considers the document to be of educational value to its members. Catheterization and Cardiovascular Interventions 85:E175-E196 (2015)TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for rightsided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

show abstract

Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation

Abstract: Prolonged CPR rescue by ECMO provides an acceptable survival rate and outcome in survivors. Our results of the selected cases encourage further investigations of the wider application of ECMO in CPR.

Cited by 330 publications

References 28 publications

Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

Contact Info

Product

Resources

About