Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support

Kagawa, Eisuke; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Sakai, Yuji; Kurisu, Satoshi; Nakama, Yasuharu; Dai, Kazuoki; Otani, Takayuki; Ikenaga, Hiroki; Morimoto, Youichi; Ejiri, Kentaro; Oda, Nozomu

doi:10.1016/j.resuscitation.2010.03.037

Cited by 233 publications

(191 citation statements)

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“…However, studies comparing outcomes in out-of-hospital vs. in-hospital cardiac arrest suggest that survival is better in patients who experience in-hospital cardiac arrest (19). The previously discussed meta-analysis failed to identify a clear survival benefit in patents who experienced outof-hospital cardiac arrest, whereas a survival benefit was observed in hospitalized patients who experienced cardiac arrest (18).…”

Section: Locationmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Yam

McMullan

2017

Ann. Transl. Med.

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Extracorporeal life support (ECLS) is used for patients in isolated or combined cardiopulmonary failures. The use of ECLS to rescue patients with cardiac arrest that is refractory to conventional cardiopulmonary resuscitation has been shown to improve survival in many patient populations. Increasing recognition of the survival benefit associated with extracorporeal cardiopulmonary resuscitation (ECPR) has led to increased use of ECPR during the past decade. This review provides an overview of ECPR utilization; population-based clinical outcomes, resource utilization and costs associated this advanced form of life support therapy.

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Section: Locationmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Yam

McMullan

2017

Ann. Transl. Med.

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“…8,16 We performed ECPR using the Capiox emergent bypass system, the Capiox-SX membrane oxygenator, and the Terumo EBS centrifugal pump (Terumo Inc, Tokyo, Japan).…”

Section: Ecmo Systemmentioning

confidence: 99%

Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest?

et al. 2012

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Background-Extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI) may be useful in cardiopulmonary resuscitation. However, little is known about the combination of ECMO and intra-arrest PCI. This study investigated the efficacy of rapid-response ECMO and intra-arrest PCI in patients with cardiac arrest complicated by acute coronary syndrome who were unresponsive to conventional cardiopulmonary resuscitation. Methods and Results-This multicenter cohort study was conducted with the use of the database of ECMO in Hiroshima City, Japan. Between January 2004 and May 2011, rapid-response ECMO was performed in 86 patients with acute coronary syndrome who were unresponsive to conventional CPR. The median age of the study patients was 63 years, and 81% were male. Emergency coronary angiography was performed in 81 patients (94%), and intra-arrest PCI was performed in 61 patients (71%). The rates of return of spontaneous heartbeat, 30-day survival, and favorable neurological outcomes were 88%, 29%, and 24%, respectively. All of the patients who received intra-arrest PCI achieved return of spontaneous heartbeat. In patients who survived up to day 30, the rate of out-of-hospital cardiac arrest was lower (58% versus 28%; Pϭ0.01), the intra-arrest PCI was higher (88% versus 70%; Pϭ0.04), and the time interval from collapse to the initiation of ECMO was shorter (40 [25-51] versus 54 minutes [34 -74 minutes]; Pϭ0.002). Conclusions-Rapid-response ECMO plus intra-arrest PCI is feasible and associated with improved outcomes in patients who are unresponsive to conventional cardiopulmonary resuscitation. On the basis of these findings, randomized studies of intra-arrest PCI are needed. (Circulation. 2012;126:1605-1613.)Key Words: acute coronary syndrome Ⅲ cardiac arrest Ⅲ cardiopulmonary bypass Ⅲ cardiopulmonary resuscitation Ⅲ extracorporeal membrane oxygenation C ardiac arrest is a major cause of unexpected death in developed countries and has a poor prognosis. Despite cardiopulmonary resuscitation (CPR), only a few patients are able to return to their former lifestyle. 1-5 Extracorporeal CPR (ECPR), an alternative to conventional CPR that employs extracorporeal membrane oxygenation (ECMO), has been reported to be effective for patients in whom return of spontaneous circulation (ROSC) cannot be achieved by conventional CPR. 6 -8 ECMO provides adequate temporary perfusion to organs in cardiac arrest patients before return of spontaneous heartbeat (ROSB). ECMO increases the rate of successful defibrillation, prevents rearrest due to postresuscitation myocardial dysfunction, and enables subsequent interventions. 9 Conversely, there are some cardiac arrest patients in whom ROSB is not achieved despite temporary mechanical circulatory assistance by venoarterial ECMO. A high incidence of acute coronary syndrome (ACS) is reported in cardiac arrest patients, and it has been noted recently that the use of percutaneous coronary intervention (PCI) in postresuscitation care improves their outcome. 6,10 -14 In...

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“…Other reports have found threshold values of fibrillation MF predicting the results of defibrillation (11,17,19). On the other hand, in contrast to many published data, the extensive variability of the results in VF characteristics has been provided (2-10).…”

Section: Mf During Full-flow Ecmo Phase and Resuscitabilitymentioning

confidence: 99%

“…It has been shown that duration of VF, effectiveness of cardiopulmonary resuscitation (CPR) (2,(11)(12)(13)(14) or administration of vasopressors (15,16) can cause changes in the power spectrum of the VF wavelet frequency with an attendant chance for return of spontaneous circulation (ROSC) rate (2,(11)(12)(13)(14)(15)(16). Extracorporeal membrane oxygenation (ECMO) is increasingly used in adult cardiac arrest (CA) of any rhythm (17)(18)(19)(20)(21)(22)(23)(24)(25). This approach is aimed to sustain vital organ perfusion during CA to provide time span for diagnosis and therapy (23).…”

Section: Introductionmentioning

confidence: 99%

Median Frequencies of Prolonged Ventricular Fibrillation treated by V-A ECMO Correspond to a Return of Spontaneous Circulation Rate

et al. 2014

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Background The aim of our study was to analyze, in a pig model of prolonged ventricular fibrillation (VF) treated by veno-arterial extracorporeal membrane oxygenation (ECMO), the time dependent changes of VF wavelet frequency obtained from intracardial signals and its relations to return of spontaneous circulation (ROSC). Methods 11 female pigs (50.3 ± 3.4 kg) under general anesthesia had undergone 15 min of VF with ECMO flow of 5 to 10 ml/kg per min simulating “untreated” VF followed by continued VF with full ECMO flow of 100 ml/kg per min. The median frequency (MF) of VF from right ventricular apex, coronary perfusion pressure, myocardial oxygen metabolism and resuscitability were determined. Results Median (interquartile range) of MF of fibrillatory wavelets in minute 15 of low ECMO flow [9.7 Hz (8.3; 10.1)] was not significantly changed in comparison to minute 1 [10.5 Hz (9.8; 12.4)], p = 0.12. Five minutes after full ECMO initiation MF increased [11.6 Hz (10.6; 13.5)], p = 0.04 (compared to minute 15 of VF) and did not deteriorate during the rest of ECMO treatment. Out of all subjects, three animals did not reach ROSC. Those subjects demonstrated deeper decrease of MF at the VF minute 15 as compared to others [-2.4 Hz (-2.5; −2.3) vs. −0.6 Hz (-1.6; −0.1)] and continuously significantly higher increase in MF on full ECMO support [4.3 Hz (2.9; 5.6) vs. 1.1 Hz (0.6; 1.6)] with p = 0.05 for both observations, respectively. Conclusions The veno-arterial ECMO reperfusion influences MF of VF wavelet obtained from right ventricular apex. The course of changes in wavelet frequency corresponds to a presence of later ROSC.

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Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support

Cited by 233 publications

References 13 publications

Extracorporeal cardiopulmonary resuscitation

Extracorporeal cardiopulmonary resuscitation

Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest?

Median Frequencies of Prolonged Ventricular Fibrillation treated by V-A ECMO Correspond to a Return of Spontaneous Circulation Rate

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