Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study

Lunz, Dirk; Calabrò, Lorenzo; Belliato, Mirko; Contri, Enrico; Broman, Lars; Scandroglio, Anna Maria; Patricio, Daniel; Malfertheiner, Maximilian; Créteur, Jacques; Philipp, Alois; Taccone, Fabio Silvio; Pappalardo, Federico

doi:10.1007/s00134-020-05926-6

Cited by 102 publications

(105 citation statements)

References 35 publications

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“…In recent years, many tertiary centres have started to use eCPR with intention to rescue OHCA patients without ROSC, whose outcome would otherwise have been fatal. Indeed, initial reports of single cases and small series suggested that eCPR may be able to rescue a substantial proportion of patients [16,17]. However, eCPR is obviously a very resource-intensive strategy and cannot be applied to all OHCA patients, at least not with current devices and in current settings.…”

Section: Discussionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest

et al. 2020

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Background Out-of-hospital cardiac arrest (OHCA) refractory to conventional high-quality cardiopulmonary resuscitation (CPR) may be rescued by extracorporeal CPR (eCPR) using veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Even when trying to identify eCPR candidates based on criteria assumed to be associated with a favourable neurological outcome, reported survival rates are frequently below 10%. Methods All patients undergoing implantation of V-A ECMO for eCPR between January 2018 and December 2019 (N = 40) were analysed (age 53±13 years; 75% male). Patients with refractory OHCA and potentially favourable circumstances (initial shockable rhythm, witnessed arrest, bystander CPR, absence of limiting comorbidities, age <75 years) were transported under mechanical chest compression. Candidates for eCPR should have a pH �6.9, arterial lactate �15 mmol/L and time-to-ECMO should be �60 minutes. Results Overall 30-day survival was 12.5%, with 3 of 5 survivors having a favourable neurological outcome (cerebral performance category (CPC) 1 or 2), representing 7.5% of the total eCPR population. No patient selected for eCPR met all pre-defined criteria (median of unfavourable criteria: 3). Importantly, time-to-ECMO most often (39/40) exceeded 60 minutes (mean 102 ±32 min.), and lactate was >15mmol/L in 30 out of 40 patients. Moreover, 22 out of 40 patients had a non-shockable rhythm on the first ECG.

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Section: Discussionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest

et al. 2020

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“…32 In 423 patients receiving E-CPR, favorable neurologic outcome rate was significantly higher in the IHCA group (34%) compared to the OHCA group (9%), although the latter had a significantly longer time from collapse to E-CPR. 33 Survival differences were even more dramatic between IHCA (42%) and OHCA (15%) groups among 85 non-postcardiotomy patients; however, the finding is complicated by a significantly shorter C-CPR duration in the IHCA group. 34 A systematic review of refractory OHCA found a survival rate of 22%, and 13% had satisfactory neurologic recovery, 35 which is comparable to the 12% favorable neurologic rate in 260 E-CPR OHCAs.…”

Section: E-cpr For Ohca Versus Ihcamentioning

confidence: 90%

“…25 A retrospective multi-center study involving 258 E-CPR OHCAs found that intensive care unit (ICU) survival was 24%, and 19% had favorable neurologic outcomes. 33 Further, a retrospective chart review involving 20 E-CPR OHCAs due to ventricular fibrillation revealed a 95% sustained return of spontaneous circulation (ROSC), 50% survival at discharge, 50% survival 1 year after discharge, and 40% adequate neurologic function at discharge. 36 A cohort study featuring 1,796 E-CPR OHCA patients reported 29% survival to discharge, and survival did not significantly change across cohorts 37 ; this is similar to the rate described in a propensity-matched study of 24 E-CPR OHCA patients.…”

Section: E-cpr For Ohca Versus Ihcamentioning

confidence: 99%

CPR and ECMO: The Next Frontier

Ambinder

Oberdier

Miklin

et al. 2020

Rambam Maimonides Med J

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Cardiopulmonary resuscitation (CPR) is a first-line therapy for sudden cardiac arrest, while extracorporeal membrane oxygenation (ECMO) has traditionally been used as a means of countering circulatory failure. However, new advances dictate that CPR and ECMO could be complementary for support after cardiac arrest. This review details the emerging science, technology, and clinical application that are enabling the new paradigm of these iconic circulatory support modalities in the setting of cardiac arrest.

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“…Recent studies have examined which ECPR factors are related to the patient's outcome [5][6][7][8][9][10]. In particular, age, witnessed cardiac arrest, bystander cardiopulmonary resuscitation (BCPR) and initial shockable rhythm (ventricular fibrillation [VF] or ventricular tachycardia [VT]) were strongly associated with improvements in mortality and neurological outcomes, and are therefore included in the indications for ECPR in most departments.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, age, witnessed cardiac arrest, bystander cardiopulmonary resuscitation (BCPR) and initial shockable rhythm (ventricular fibrillation [VF] or ventricular tachycardia [VT]) were strongly associated with improvements in mortality and neurological outcomes, and are therefore included in the indications for ECPR in most departments. Currently, ECPR should be initiated < 60 min after the patient collapses [4,5].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation without target temperature management for out-of-hospital cardiac arrest patients prolongs the therapeutic time window: a retrospective analysis of a nationwide multicentre observational study in Japan

et al. 2020

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Background: Extracorporeal cardiopulmonary resuscitation (ECPR) with extracorporeal membrane oxygenation (ECMO) is a promising therapy for out-of-hospital cardiac arrest (OHCA) compared with conventional cardiopulmonary resuscitation (CCPR). The no and low-flow time (NLT), the interval from collapse to reperfusion to starting ECMO or to the return of spontaneous circulation (ROSC) in CCPR, is associated with the neurological outcome of OHCA. Because the effects of target temperature management (TTM) on the outcomes of ECPR are unclear, we compared the neurological outcomes of OHCA between ECPR and CCPR without TTM. Methods: We performed retrospective subanalyses of the Japanese Association for Acute Medicine OHCA registry. Witnessed cases of adult cardiogenic OHCA without TTM were selected. We performed univariate, multivariable and propensity score analyses to compare the neurological outcomes after ECPR or CCPR in all eligible patients and in patients with NLT of > 30 min or > 45 min. Results: We analysed 2585 cases. Propensity score analysis showed negative result in all patients (odds ratio 0.328 [95% confidence interval 0.141-0.761], P = 0.010). However, significant associated with better neurological outcome was shown in patients with NLT of > 30 min or > 45 min (odds ratio 2.977 [95% confidence interval 1.056-8.388], P = 0.039, odds ratio 5.099 [95% confidence interval 1.259-20.657], P = 0.023, respectively). Conclusion: This study revealed significant differences in the neurological outcomes between ECPR and CCPR without TTM, in patients with NLT of > 30 min.

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Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study

Cited by 102 publications

References 35 publications

Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest

Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest

CPR and ECMO: The Next Frontier

Extracorporeal cardiopulmonary resuscitation without target temperature management for out-of-hospital cardiac arrest patients prolongs the therapeutic time window: a retrospective analysis of a nationwide multicentre observational study in Japan

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