Improving Patient Selection for Refractory Out of Hospital Cardiac Arrest Treated with Extracorporeal Life Support

Chouihed, Tahar; Kimmoun, Antoine; Lauvray, Adrien; Laithier, François-Xavier; Jaeger, Déborah; Lemoine, Simon; Maureira, Juan Pablo; Nace, Lionel; Duarte, Kévin; Albizzati, Stéphane; Girerd, Nicolas; Lévy, Bruno

doi:10.1097/shk.0000000000000941

Cited by 18 publications

(8 citation statements)

References 13 publications

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“…These findings are consistent with a recent study demonstrating an improved outcome after implementation of a standardized ECPR protocol at a single center. 41 Furthermore, a recent RCT on ECPR vs. CCPR (ARREST trial) demonstrated that early initiation ECMO resulted in an impressive 43% survival to hospital discharge for refractory shockable rhythm. Despite the small sample size, the study demonstrated that ECPR care in an experienced centre with expertise, and streamlined ECPR protocols and transport system can dramatically improve survival and neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Huang

Shoskes

Migdady

et al. 2021

J Intensive Care Med

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Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

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Section: Discussionmentioning

confidence: 99%

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Huang

Shoskes

Migdady

et al. 2021

J Intensive Care Med

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“…After excluding the duplicated papers, review or meeting abstracts, and irrelevant articles, 60 articles were left for further screening by checking the full texts. 47 articles were excluded, of which, seven were overlapped studies [42][43][44][45][46][47][48], seven were performed in pediatric patients [49][50][51][52][53][54][55], two study contained patients with other disease besides CA and the data related to CA could not be obtained separately [16,56], three studies contained CA patients treated with other methods besides ECPR and the data related to ECPR could not be obtained separately [17,57,58], fifteen studies had no sufficient data [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73], and eleven studies only had therapeutic hypothermia arms (without controls) [37,[74][75][76][77][78][79][80][81][82][83]. Two...…”

Section: Discussionmentioning

confidence: 99%

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

Chen

Zhen

Jia

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Therapeutic hypothermia has been recommended for eligible patients after cardiac arrest (CA) in order to improve outcomes. Up to now, several comparative observational studies have evaluated the combined use of extracorporeal cardiopulmonary resuscitation (ECPR) and therapeutic hypothermia in adult patients with CA. However, the effects of therapeutic hypothermia in adult CA patients receiving ECPR are inconsistent. Methods: Relevant studies in English databases (PubMed, ISI web of science, OVID, and Embase) were systematically searched up to September 2019. Odds ratios (ORs) from eligible studies were extracted and pooled to summarize the associations of therapeutic hypothermia with favorable neurological outcomes and survival in adult CA patients receiving ECPR.Results: 13 articles were included in the present meta-analysis study. There were nine studies with a total of 806 cases reporting the association of therapeutic hypothermia with neurological outcomes in CA patients receiving ECPR. Pooling analysis suggested that therapeutic hypothermia was significantly associated with favorable neurological outcomes in overall (N = 9, OR = 3.507, 95%CI = 2.194-5.607, P < 0.001, fixed-effects model) and in all subgroups according to control type, regions, sample size, CA location, ORs obtained methods, follow-up period, and modified Newcastle Ottawa Scale (mNOS) scores. There were nine studies with a total of 806 cases assessing the association of therapeutic hypothermia with survival in CA patients receiving ECPR. After pooling the ORs, therapeutic hypothermia was found to be significantly associated with survival in overall (N = 9, OR = 2.540, 95%CI = 1.245-5.180, P = 0.010, random-effects model) and in some subgroups. Publication bias was found when evaluating the association of therapeutic hypothermia with neurological outcomes in CA patients receiving ECPR. Additional trim-and-fill analysis estimated four "missing" studies, which adjusted the effect size to 2.800 (95%CI = 1.842-4.526, P < 0.001, fixed-effects model) for neurological outcomes.Conclusions: Therapeutic hypothermia may be associated with favorable neurological outcomes and survival in adult CA patients undergoing ECPR. However, the result should be treated carefully because it is a synthesis of low-level evidence and other limitations exist in present study. It is necessary to perform randomized controlled trials to validate our result before considering the result in clinical practices.

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“…Allein durch die Tatsache, dass strukturiert vorgegangen, also ein Standard oder Protokoll verwendet wird, und dass eine rigorose Patientenauswahl erfolgt, können Prozesszeiten verbessert und Überlebensraten gesteigert werden [3,6,9]. Auch hier ist bezüglich der Vergleichbarkeit von Daten jedoch anzumerken, dass die Endpunkte in der Literatur unterschiedlich definiert sind, und mit Überlebensrate nicht immer nur neurologisch günstiges Überleben gemeint ist, was eine Interpretation erschwert.…”

Section: Welche Patienten Kommen Für Ecpr In Frage Und Welche Nicht?unclassified

eCPR bei prähospitalem therapierefraktärem Herz-Kreislauf-Stillstand

Damjanović

Gliwitzky²,

Deppe

et al. 2019

Notfall Rettungsmed

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Improving Patient Selection for Refractory Out of Hospital Cardiac Arrest Treated with Extracorporeal Life Support

Abstract: The use of a new paradigm of ROHCA dramatically shortened the time to ECLS initiation by reducing the time spent on site by more than 20 min. Survival improved from 7% to 25% after implementation of OSCAR-ECLS.

Cited by 18 publications

References 13 publications

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

eCPR bei prähospitalem therapierefraktärem Herz-Kreislauf-Stillstand

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