Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation

Siao, Fu-Yuan; Chiu, Chun-Chieh; Chiu, Chun-Wen; Chen, Ying‐Chen; Chen, Yao‐Li; Hsieh, Yung‐Kun; Lee, Chien‐Hui; Wu, Chang-Te; Chou, Chu-Chung; Yen, Hsu‐Heng

doi:10.1016/j.resuscitation.2015.04.016

Cited by 116 publications

(102 citation statements)

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“…Only ECLS if CPR >10 min or repetitive arrest events without ROSC >20 min. No ECLS if unwitnessed OHCA or no bystander CPRConventional CPR81874596469656741––43 (21–60)30 (15–48)––Maekawa et al [15]Witnessed OHCA of presumed cardiac origin, CPR >20 minInitiation of ECPR was dependent on the attending physiciansConventional CPR5310954718373––406 b 49 (41–59)56 (47–66)2 (0–8)5 (0–9)Sakamoto et al [16]OHCA based on VF/VT, no ROSC >15 min after hospital arrival, <45 min between emergency call and hospital arrival; cardiac originAssignment of facility to ECPR or CPR groupConventional CPR2601945658908964593811 b ––––Shin et al [17]IHCA, witnessed, CPR >10 minAccording to the discretion of the CPR team leaderConventional CPR85321606262634526417 a 42 ± 2641 ± 37– d – d Siao et al [18]Cardiac arrest with initial VF (start CPR <5 min), no ROSC after 10 min CPR…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

et al. 2016

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PurposeVeno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest and cardiogenic shock, to support both cardiac and pulmonary function. We performed a systematic review and meta-analysis of cohort studies comparing mortality in patients treated with and without ECLS support in the setting of refractory cardiac arrest and cardiogenic shock complicating acute myocardial infarction.MethodsWe systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed updated to December 2015. Thirteen studies were included of which nine included cardiac arrest patients (n = 3098) and four included patients with cardiogenic shock after acute myocardial infarction (n = 235). Data were pooled by a Mantel-Haenzel random effects model and heterogeneity was examined by the I 2 statistic.ResultsIn cardiac arrest, the use of ECLS was associated with an absolute increase of 30 days survival of 13 % compared with patients in which ECLS was not used [95 % CI 6–20 %; p < 0.001; number needed to treat (NNT) 7.7] and a higher rate of favourable neurological outcome at 30 days (absolute risk difference 14 %; 95 % CI 7–20 %; p < 0.0001; NNT 7.1). Propensity matched analysis, including 5 studies and 438 patients (219 in both groups), showed similar results. In cardiogenic shock, ECLS showed a 33 % higher 30-day survival compared with IABP (95 % CI, 14–52 %; p < 0.001; NNT 13) but no difference when compared with TandemHeart/Impella (−3 %; 95 % CI −21 to 14 %; p = 0.70; NNH 33).ConclusionsIn cardiac arrest, the use of ECLS was associated with an increased survival rate as well as an increase in favourable neurological outcome. In the setting of cardiogenic shock there was an increased survival with ECLS compared with IABP.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-016-4536-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

et al. 2016

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“…[5][6][7][8][9] While no prospective randomized studies have been completed examining the outcomes of ECPRtreated patients in comparison to conventional resuscitation, ECPR for OHCA is typically initiated between 45 and 75 minutes after the initial cardiac arrest, 6,7 an elapsed duration of resuscitation at which survival with conventional resuscitation appears to be rare. 17 The Alfred Hospital and Victorian EMS system in Melbourne, Australia, which provides similar hospital and pre-hospital services to those in our region, recently described the results of an ECPR protocol, demonstrating 56% neurologically intact survival in a carefully selected group of patients with refractory OHCA treated with ECPR.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] Survival rates have been reported up to approximately 50%. [5][6][7][8][9] Although ECPR may increase the proportion of survivors in selected OHCA patients, it is a resourceintensive therapy, requiring the attendance of a specially trained team that may include physicians, surgeons, cardiac perfusionists, and skilled nursing staff, as well as specialized protocols, equipment, and hospital resources. The aims of this descriptive study were: (1) to identify patients within our region who fulfilled a hypothetical set of ECPR criteria and estimate the number who would have been candidates for ECPR therapy; and (2) to determine the baseline outcomes of ECPR-eligible patients treated with conventional resuscitation to estimate the potential gains of an ECPR program.…”

Section: Introductionmentioning

confidence: 99%

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Grunau

Scheuermeyer

Stub

et al. 2016

CJEM

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Objective: Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. Methods: We performed a secondary analysis from a 52-month prospective registry of consecutive adult nontraumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge. Results: Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge. Conclusion: In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes. RÉSUMÉObjectif: La réanimation cardiorespiratoire extracorporelle (RCREC), bien qu'elle soit exigeante sur le plan des ressources, peut améliorer les résultats cliniques chez certains patients ayant subi un arrêt cardiaque extrahospitalier (ACEH) réfrac-taire. Les auteurs de l'étude cherchaient à déterminer les patients qui répondaient aux un ensemble de critères de la RCREC afin d'estimer, d'une part, la proportion de patients ayant subi un arrêt cardiaque réfractaire qui auraient pu profiter de la méthode de réanimation et, d'autre part, les résultats cliniques obtenus par la méthode habituelle de réanimation. Méthode: Les auteurs ont procédé à une analyse secondaire d'un registre prospectif, constitué de cas consécutifs d'ACEH non traumatique, survenus chez des adultes, sur une période de 52 mois, dans une seule région sanitaire urbaine d'un million de personnes, au Canada. Les auteurs ont formé une cohorte fictive d'adultes, âgés de moins de 60 ans, susceptibles d'être traités par la RCREC après avoir subi un ACEH devant des témoins et avoir fait l'objet de manoeuvres de réanimation cardiorespiratoire par des passants ou avoir reçu des soins donnés par des services médicaux d'urgence (SMU), et ce, en l'espace de cinq minutes. Le principal critère d'éval...

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“…Siao et al suggested that VF is refractory if no return of spontaneous circulation is achieved after more than 10 min of conventional ACLS effort. 29 However, in their series this definition translated into a mean duration of resuscitation effort before ECMO was begun of 69.9±49.6 min. They also suggested that at least 3 shocks be delivered in patients with shockable rhythms before such are considered refractory.…”

Section: Safety Of the Ems Crewmentioning

confidence: 99%

Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory

William

Rao

Kanakadandi

et al. 2016

Circ J

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Cardiac arrest, though not common during coronary angiography, is increasingly occurring in the catheterization laboratory because of the expanding complexity of percutaneous interventions (PCI) and the patient population being treated. Manual chest compression in the cath lab is not easily performed, often interrupted, and can result in the provider experiencing excessive radiation exposure. Mechanical cardiopulmonary resuscitation (CPR) provides unique advantages over manual performance of chest compression for treating cardiac arrest in the cardiac cath lab. Such advantages include the potential for uninterrupted chest compressions, less radiation exposure, better quality chest compressions, and less crowded conditions around the catheterization table, allowing more attention to ongoing PCI efforts during CPR. Out-of-hospital cardiac arrest patients not responding to standard ACLS therapy can be transported to the hospital while mechanical CPR is being performed to provide safe and continuous chest compressions en route. Once at the hospital, advanced circulatory support can be instituted during ongoing mechanical CPR. This article summarizes the epidemiology, pathophysiology and nature of cardiac arrest in the cardiac cath lab and discusses the mechanics of CPR and defibrillation in that setting. It also reviews the various types of mechanical CPR and their potential roles in and on the way to the laboratory. (Circ J 2016; 80: 1292 -1299

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Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation

Cited by 116 publications

References 32 publications

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory

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