Extracorporeal Cardiopulmonary Resuscitation for Patients With Out-of-Hospital Cardiac Arrest of Cardiac Origin

Maekawa, Kunihiko; Tanno, Katsutoshi; Hase, Mamoru; Mori, Kazuhisa; Asai, Yasufumi

doi:10.1097/ccm.0b013e31827ca4c8

Cited by 334 publications

(295 citation statements)

References 26 publications

(34 reference statements)

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“…Shortening these delays to treatment should improve the prognosis. Indeed, Maekawa et al (14) reported a median low-flow times of 49 min, which were associated with hospital discharge of 29%. Similarly, Wang et al (16) reported a mean lowflow time of 67 min for OHCA with rate of survival of 25.8%.…”

Section: Discussionmentioning

confidence: 99%

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

et al. 2017

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Extracorporeal life support (ECLS) has shown benefits in the management of refractory inhospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P 5 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P 5 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS. Key Words: Extracorporeal life support-Cardiac arrestCardiopulmonary resuscitation.Conventional management of cardiac arrest (CA) has evolved considerably in recent years, nevertheless mortality is still high (1,2). This is essentially related to the neurological prognosis and thus to cerebral damage due to ischemia and reperfusion injury. Given this, the management of CA should focus on maintaining effective circulation during the external cardiac massage and to manage adequately the return to spontaneous circulation.The use of extracorporeal life support (ECLS) for the management of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) has been widely described (3). Nonetheless, doubts have been expressed about the usefulness of ECLS in OHCA (4). Indeed, rapid ECLS implementation is a major concern. However, in large towns with heavy traffic, timely implementation of ECLS and restoration of effective circulation is sometimes very long.To update our management practices and to determine the usefulness of ECLS in OHCA, we conducted a retrospective study of all IHCA and OHCA treated with ECLS to compare survival and the neurological prognosis of our patients.

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Section: Discussionmentioning

confidence: 99%

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

et al. 2017

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“…There were no published randomized controlled trials (RCTs) although two (NCT01511666 and NCT01605409) are currently enrolling patients in Prague and Vienna. 10,11 Four of the selected studies were conducted in Japan, 2 in Korea and 1 in Taiwan, [12][13][14][15][16][17][18] 5 in France, 19-23 2 in Germany 24,25 and 2 in Italy. 26,27 The remaining case series and reports were from Belgium, 28 Austria, 29 USA 30 and Australia.…”

Section: Ecpr Studiesmentioning

confidence: 99%

“…31 The large majority of included studies were case reports, case series, and retrospective cohort studies, all of them LOE of 4. Maekawa et al 13 and Kim et al 12 performed a post hoc analysis of a prospective observational study, LOE 3. Sakamoto et al 16 completed a large prospective observational study (LOE 2) which is the strongest level of evidence identified.…”

Section: Ecpr Studiesmentioning

confidence: 99%

“…Most of the included studies presented high risk of confounding bias and threats to external validity because of their observational design. However, the methodological quality assessment of the 20 included studies resulted in a rating of good for 14 studies [12][13][14][15][16]18,20,[22][23][24][25][26][27][28] and fair for the other 6 17,19,21,29-31 (see Table 1). …”

Section: Ecpr Studiesmentioning

confidence: 99%

“…The main exclusion criteria were the pre-existence of severe comorbidities, neurological disabilities, a valid do not attempt resuscitation order and the identification of a primary non-cardiac etiology (Table 2). • Catheter Lab + IABP: 1 study 17 • Catheter Lab + IABP + TTM: 9 studies [13][14][15][16][18][19][20]26,27 CPR, cardiopulmonary resuscitation; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; TTM, targeted temperature management, also known as therapeutic mild hypothermia; IABP, intra-aortic balloon pump.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Shapiro

Josephson

Rosenfeld³

et al. 2017

Annals ATS

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a b s t r a c tAim: Extracorporeal resuscitation during cardiopulmonary resuscitation (ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated circulation until the return of spontaneous circulation (ROSC). The purpose of this systematic review is to address the defining elements and outcomes (quality survival and organ donation) of currently active protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of cardiac origin in adult patients. The results may inform policy and practices for ECPR and help clarify the corrresponding intersection with deceased organ donation. Methods: We searched Medline, Embase, Cochrane and seven other electronic databases from 2005 to 2015, with no language restrictions. Internal validity and the quality of the studies reporting outcomes and guidelines were assessed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015259). Results: One guideline and 20 outcome studies were analyzed. Half of the studies were prospective observational studies assessed to be of fair to good methodological quality. The remainder were retrospective cohorts, case series, and case studies. Ages ranged from 16 to 75 years and initial shockable cardiac rhythms, witnessed events, and a reversible primary cause of cardiac arrest were considered favorable prognostic factors. CPR duration and time to hospital cannulation varied considerably. Coronary revascularization, hemodynamic interventions and targeted temperature management neuroprotection were variable. A total of 833 patients receiving this ECPR approach had an overall reported survival rate of Abbreviations: ECPR, extracorporeal resuscitation; ROSC, return of spontaneous circulation; OHCA, out-of-hospital cardiac arrest; CPC, cerebral performance category; GOS, Glasgow Outcome Scale; LOE, level of evidence; ILCOR, International Liaison Committee on Resuscitation; RCTs, randomized controlled trials; TTM, targeted temperature management; IABP, intra-aortic balloon pump; DBD, donation after brain death; cDCD, controlled donation after circulatory determination of death; ELSO, extracorporeal life support organization. I. Ortega-Deballon et al. / Resuscitation 101 (2016) 12-20 13 22%, including 13% with good neurological recovery. Additionally, 88 potential and 17 actual deceased organ donors were identified among the non-survivor population in 8 out of 20 included studies. Study heterogeneity precluded a meta-analysis preventing any meaningful comparison between protocols, interventions and outcomes. Conclusions: ECPR is feasible for refractory OHCA of cardiac origin in adult patients. It may enable neurologically good survival in selected patients, who practically have no other alternative in order to save their lives with quality of life, and contribute to organ donation in those who die. Large, prospective studies are required to clarify patient selection, modifiable outcome variables, risk-benefit and cost-effectiveness.

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Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest

Bělohlávek

Šmalcová

Rob

et al. 2022

JAMA

281

227

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Key PointsQuestionIn patients with witnessed refractory out-of-hospital cardiac arrest, does early intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and invasive assessment and treatment improve outcomes compared with standard resuscitation?FindingsIn this randomized clinical trial that included 256 patients, survival with neurologically favorable outcome (Cerebral Performance Category 1-2) at 180 days occurred in 31.5% in the invasive strategy group and 22.0% in the standard resuscitation group, a difference that was not statistically significant.MeaningAmong patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation, although the trial was possibly underpowered to detect a clinically relevant difference.

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Extracorporeal Cardiopulmonary Resuscitation for Patients With Out-of-Hospital Cardiac Arrest of Cardiac Origin

Abstract: Extracorporeal cardiopulmonary resuscitation can improve neurologic outcome after out-of-hospital cardiac arrest of cardiac origin; furthermore, pupil diameter on hospital arrival may be a key predictor to identify extracorporeal cardiopulmonary resuscitation candidates.

Cited by 334 publications

References 26 publications

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest

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