Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: Analysis of the extracorporeal life support organization registry

Shou, Benjamin L.; Ong, Chin Siang; Premraj, Lavienraj; Brown, Patricia M.; Tonna, Joseph E.; Dalton, Heidi J.; Kim, Bo Soo; Keller, Steven P.; Whitman, Glenn; Cho, Sung Min

doi:10.1016/j.healun.2022.10.019

Cited by 21 publications

(24 citation statements)

References 30 publications

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“…We conducted subgroup analyses according to the cut-off used by the authors for the de nition of hyperoxemia. Whilst most studies have used 300 mmHg as cut-off to de ne severe hyperoxemia [18,19,[25][26][27][28][29]33], others have used more conservative threshold (i.e. 200 mmHg [30,31] ), and sporadically also a higher one (400 mmHg) has been reported [27].…”

Section: Discussionmentioning

confidence: 99%

“…we received no answer after multiple email attempts to contact the corresponding and/or the senior author. Therefore, we nally, we included 11 articles[18, 19,[25][26][27][28][29][30][31][32][33], all of them published in the 2017-2023 period.…”

Section: Study Selectionmentioning

confidence: 99%

“…Of note, one of the included studies reported neurological outcome as "acute brain injury" (a composite outcome that included also seizures) and not according to CPC or mRS. Hence, for the neurological outcome endpoint, this study was used only in the sensitivity analysis [25]. Another study separated the data of CS and eCPR [33], but we used data from the eCPR sub-population only because data from the CS subpopulation were reported by another study [28].…”

Section: Study Selectionmentioning

confidence: 99%

“…The four types analyses planned mostly con rmed the results of the primary analysis. The rst sensitivity analysis was conducted including data only from studies that provided adjusted ORs only, thereby including six studies reporting mortality[18, 25,27,28,31,33] and two describing neurological outcome [27,31]. In this analysis, we con rmed that hyperoxemia was consistently associated with increased mortality (OR 1.72 [1.00-2.97], p = 0.05, I 2 = 86%) and poor neurological outcome (OR 1.99 [1.18-3.37], p = 0.01, I 2 = 0%).…”

Section: Sensitivity Analysesmentioning

confidence: 99%

“…As mentioned, Shou et al [25] did not report data on neurological outcome according to our PECOS criteria, but rather reported the pooled data on major neurological complications, de ned as a composite outcome of "acute brain injury". Another study [34] was excluded as classi ed patients according to the duration of hyperoxemia and not to exposure.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

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Exposure to hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: a meta-analysis

Tigano

Caruso

Liotta

et al. 2023

Preprint

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Background Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or refractory cardiac arrest (CA). Exposure to hyperoxemia is common during VA-ECMO, and its impact on patient’s outcome remains unclear. Methods We conducted a systematic review (PubMed and Scopus) and metanalysis investigating the effects of exposure to hyperoxemia on mortality and poor neurological outcome in patients supported by VA-ECMO. Whenever provided, we used the Odds Ratio (OR) adjusted for confounders. Results are reported as OR and 95% confidence interval (CI). Subgroup analyses were conducted according to VA-ECMO indication and hyperoxemia thresholds. Results Data from 11 observational studies were included. Ten studies reported data on mortality (6 on refractory CA and 4 on CS), and 4 on neurological outcome. Hyperoxemia exposure was associated with higher mortality (OR:1.81, 95%CI [1.22–2.71]; p = 0.003; I2 = 81%) and worse neurological outcome (OR:1.97, 95%CI [1.30–2.96]; p = 0.001; I2 = 0%). Magnitude and effect of these findings remained valid in subgroup analyses conducted according to different hyperoxemia thresholds (> 200 or > 300 mmHg) and VA-ECMO indication, although the association with mortality remained uncertain in the refractory CA population (p = 0.07). Analysis restricted only to studies providing data in adjusted OR confirmed the increased mortality (OR:1.72, 95%CI [1.00-2.97]; p = 0.05) and poorer neurological outcome (OR:1.99, 95%CI [1.18–3.37]; p = 0.01) in patients exposed to hyperoxemia. Conclusions Hyperoxemia exposure after initiation of VA-ECMO is associated with an almost doubled increased probability of poor neurological outcome and mortality. Clinical efforts should be made to avoid severe hyperoxemia during VA-ECMO support.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Sensitivity Analysesmentioning

confidence: 99%

Section: Sensitivity Analysesmentioning

confidence: 99%

See 3 more Smart Citations

Exposure to hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: a meta-analysis

Tigano

Caruso

Liotta

et al. 2023

Preprint

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The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life‐saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.

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Machine Learning from Veno-Venous Extracorporeal Membrane Oxygenation Identifies Factors Associated with Neurological Outcomes

Leng,

Shou,

Liu

et al. 2024

Lung

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Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: Analysis of the extracorporeal life support organization registry

Cited by 21 publications

References 30 publications

Exposure to hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: a meta-analysis

Exposure to hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: a meta-analysis

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Machine Learning from Veno-Venous Extracorporeal Membrane Oxygenation Identifies Factors Associated with Neurological Outcomes

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