Pneumonia and Extracorporeal Cardiopulmonary Resuscitation Followed by Targeted Temperature Management in Patients With Out-of-Hospital Cardiac Arrest　― Retrospective Cohort Study ―

Abstract

poreal life support (ECLS), there is no standard policy regarding prophylactic antibiotics for patients on ECLS, including ECPR, because of the lack of studies on infectious complications during ECPR. 12 Therefore, we hypothesized that initiation of ECPR is a risk factor for infectious complications. To address this hypothesis, this observational study examined the association between initiation of ECPR and the incidence of infectious complications, such as pneumonia, sepsis, and bacteremia, in patients with OHCA who received TTM, and also assessed infection management during ECPR. Methods Patients This retrospective study used data from hospital medical records of patients with OHCA treated with TTM who E xtracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management (TTM) has demonstrated significantly better outcome in patients with out-of-hospital cardiac arrest (OHCA). 1-4 Despite this surprising outcome, however, critical complications, such as infection, hemorrhage, and ischemia, sometimes occur during ECPR management in the intensive care unit (ICU). 5-7 Although a few observational studies did not note a significant association between infection complications and mortality in patients with OHCA or those managed with extracorporeal membrane oxygenation (ECMO), 8,9 and several observational studies examining infection have been conducted in patients with ECPR, 2,5,10,11 the details of infectious complications during ECPR have not been fully examined. According to the Extracorporeal Life Support Organization (ELSO) general guidelines for all extracor

Association between inflammation in acute phase and early onset pneumonia in patients with out‐of‐hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation

“…We have described the details of ECMO management and postresuscitation care in an intensive care unit in our previous paper. 10 In brief, core temperature was managed by internal cooling by ECMO, and a target core temperature of 34°C was maintained for 24 h, followed by gradual rewarming for the next 24 h. Then, body temperature was maintained at normothermia until 72 h after the return of spontaneous circulation. Weaning of ECMO was usually considered 48 h after the initiation when the patient was hemodynamically stable and adequately oxygenated.…”

Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out‐of‐hospital cardiac arrest from the emergency department to intensive care unit in Japan

“…Blood drawing, including not only complete blood count and blood gas but also C‐reactive protein and fibrinogen degradation products/ d ‐dimer, was undertaken during CPR in almost all institutions in the present study. This mainly reflects the characteristics of clinical practice in Japan 16,17 . Because Otani et al .…”

“…This mainly reflects the characteristics of clinical practice in Japan. 16,17 Because Otani et al reported that the D-dimer level could predict major bleeding in ECPR on admission, 18 evaluating these markers could have some significance in predicting the outcomes.…”

The use of induced hypothermia in extracorporeal membrane oxygenation: A narrative review

“…Regarding ions disturbances, a retrospective study 78 including 116 ECPR patients recently yielded that IH was associated with hypokalemia and hypophosphatemia. Shiba et al 79 also described an increased risk of pneumonia in ECRP patients treated with IH compared with others. In patients with CS needing V-A ECMO support, IH was also associated with a higher requirement of red blood cell transfusion compared with others, although the percentage of bleeding was not statistically different between groups.…”