Multidisciplinary shock team is associated with improved outcomes in patients undergoing ECPR

Abstract

Objectives: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly used in cardiopulmonary resuscitation (ECPR) in select patients. Few centers have published their experience or outcomes with ECPR. The aim of our study was to evaluate outcomes of adult patients in cardiac arrest placed on VA ECMO in the catheterization laboratory. Methods: We performed a retrospective analysis of adult patients in refractory cardiac arrest who underwent ECPR at the Minneapolis Heart Institute (MHI) at Abbott Northwestern Hospital from January 2012 to December 2017. Relevant data were obtained from electronic medical records, including arrest to ECMO flow time, total ECMO support time, and outcomes. Results: Twenty-six adult patients underwent ECPR at the study site during the defined time period. Seven patients (27%) sustained cardiac arrest out of hospital, 19 patients arrested in-hospital with eight of those occurring in the catheterization laboratory. Seventeen (65%) patients had initial rhythm of ventricular fibrillation or tachycardia (VF/VT). All patients underwent mechanical CPR with LUCAS device. Overall 30 day and 6 month survival was 69%. Median time from arrest to ECMO flow was 46 mins (21,68) vs 61 mins (36,71) in survivors and non-survivors, respectively. Sixteen of 18 survivors discharged with a CPC score of 1 or 2. Conclusions: We demonstrate that adult patients in cardiac arrest initiated on VA ECMO in the cardiac catheterization laboratory and cared for by a multidisciplinary shock team in the critical care unit have superior long-term survival and functionally favorable neurologic recovery when compared to current literature.

Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

“…The frequency of extracorporeal cardiopulmonary resuscitation (eCPR), either in out-of-hospital or in-hospital cardiac arrest (OHCA/IHCA) scenarios, is increasing due to advances in interdisciplinary treatment of these patients. 1 Moreover, mortality rates are improving in recent years, despite still relatively low overall survival. 2 In particular, eCPR remains a specialized rescue therapy and is mainly performed in high-volume centers.…”

Similarities in extracorporeal membrane oxygenation management across intensive care unit types in the United States: An analysis of the Extracorporeal Life Support Organization Registry

“…As ECMO continues to expand in indication and location, our work provides a descriptive analysis of the current state of ECMO delivery as it relates to heterogeneity within fields of cardiac and thoracic surgery 58 . In the context of prior work on the provision of ECMO, our analysis shows how there are minimal differences in on‐ECMO metrics across unit types 20,59,60 …”

Building a cardiogenic shock response team: key considerations necessary to improve outcomes

“…Similarly, investigators from the Minneapolis Heart Institute found that overall 30-day and 6-month survival for their cohort of ECPR patients was 69%, which is superior compared to current literature. Although this study included a small sample size and lacked a control group, the authors believed that their increased survival rates were in part due to a multidisciplinary shock team which streamlined the rapid initiation of high-quality CPR, skilled and timely VA-ECMO cannulation, and diligent postcannulation care [18]. In summary, although there are some limitations to each study, CS teams have been shown to provide benefit in individual, in multicenter registries, and in specific subsets of CS patients.…”

“…The critical care cardiologists would also be responsible for gathering detailed information, including clinical, laboratory and imaging data, collecting invasive hemodynamic data, and maintaining the hemodynamic support devices, if implanted [24]. Cardiothoracic surgeons or interventional cardiologists would be responsible for the implementation of MCS, including ECMO placement [24], whereas the surgical team would also be crucial in transitioning patients with refractory shock from temporary to durable MCS [18]. The interventional cardiologist should provide procedural support, including emergent cannulation for ECMO and placement of other percutaneous MCS devices, and facilitate additional structural procedures (e.g.…”