Recommandations sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires

cardiopulmonaire, Conseil français de réanimation; réanimation, Société française d'anesthésie et de; cardiologie, Société française de; cardiovasculaire, Société française de chirurgie thoracique et; d'urgence, Société française de médecine; Pédiatrie, Société Française de; pédiatriques, Groupe francophone de réanimation et d'urgence; perfusion, Société française de

doi:10.1016/j.annfar.2008.12.011

Cited by 92 publications

(27 citation statements)

References 11 publications

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“…Refractory cardiac arrest is defined by the lack of ROSC within a period of at least 30 minutes of CPR in the absence of preexisting hypothermia [1,28]. Because this condition is associated with no survival, it is an indication for stopping CPR and declaring the patient dead.…”

Section: Discussionmentioning

confidence: 99%

“…Since the start of our study (January 2009), French guidelines for the indications for the use of ECLS in refractory cardiac arrest have been published [28]. These guidelines consider the following variables to determine whether ECLS is indicated following OH cardiac arrest: duration of no flow (≤5 min), duration of low flow (≤100 min) and E T CO 2 level (≥10 mmHg), at least in nonhypothermic patients and in patients without life signs during ongoing CPR (Additional file 1) [28].…”

Section: Methodsmentioning

confidence: 99%

“…These guidelines consider the following variables to determine whether ECLS is indicated following OH cardiac arrest: duration of no flow (≤5 min), duration of low flow (≤100 min) and E T CO 2 level (≥10 mmHg), at least in nonhypothermic patients and in patients without life signs during ongoing CPR (Additional file 1) [28]. Thus we assessed whether the main criteria (no flow, low flow and E T CO 2 level) recommended in these guidelines were followed during our study and if the whole algorithm was respected.…”

Section: Methodsmentioning

confidence: 99%

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Extracorporeal life support following out-of-hospital refractory cardiac arrest

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Extracorporeal life support following out-of-hospital refractory cardiac arrest

et al. 2011

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“…This is an important finding, because the cause of arrest is of cardiac origin in a majority of cases [3,12]. It is well described that besides the primary cardiac disease, nonpulsatile ECMO flow may adversely affect cardiac performance in critical states, including hypoxemic blood perfusion of the coronary circulation due to a pulmonary dysfunction [21], changes in load-dependent contractile function [22] and pure mechanical negative effect on LV function [23].…”

Section: Discussionmentioning

confidence: 99%

Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation

et al. 2012

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IntroductionExtracorporeal membrane oxygenation (ECMO) is increasingly used in cardiac arrest (CA). Adequacy of carotid and coronary blood flows (CaBF, CoBF) and coronary perfusion pressure (CoPP) in ECMO treated CA is not well established. This study compares femoro-femoral (FF) to femoro-subclavian (FS) ECMO and intraaortic balloon counterpulsation (IABP) contribution based on CaBF, CoBF, CoPP, myocardial and brain oxygenation in experimental CA managed by ECMO.MethodsIn 11 female pigs (50.3 ± 3.4 kg), CA was randomly treated by FF versus FS ECMO ± IABP. Animals under general anesthesia had undergone 15 minutes of ventricular fibrillation (VF) with ECMO flow of 5 to 10 mL/kg/min simulating low-flow CA followed by continued VF with ECMO flow of 100 mL/kg/min. CaBF and CoBF were measured by a Doppler flow wire, cerebral and peripheral oxygenation by near infrared spectroscopy. CoPP, myocardial oxygen metabolism and resuscitability were determined.ResultsCaBF reached values > 80% of baseline in all regimens. CoBF > 80% was reached only by the FF ECMO, 90.0% (66.1, 98.6). Addition of IABP to FF ECMO decreased CoBF to 60.7% (55.1, 86.2) of baseline, P = 0.004. FS ECMO produced 70.0% (49.1, 113.2) of baseline CoBF, significantly lower than FF, P = 0.039. Addition of IABP to FS did not change the CoBF; however, it provided significantly higher flow, 76.7% (71.9, 111.2) of baseline, compared to FF + IABP, P = 0.026. Both brain and peripheral regional oxygen saturations decreased after induction of CA to 23% (15.0, 32.3) and 34% (23.5, 34.0), respectively, and normalized after ECMO institution. For brain saturations, all regimens reached values exceeding 80% of baseline, none of the comparisons between respective treatment approaches differed significantly. After a decline to 15 mmHg (9.5, 20.8) during CA, CoPP gradually rose with time to 68 mmHg (43.3, 84.0), P = 0 .003, with best recovery on FF ECMO. Resuscitability of the animals was high, both 5 and 60 minutes return of spontaneous circulation occured in eight animals (73%).ConclusionsIn a pig model of CA, both FF and FS ECMO assure adequate brain perfusion and oxygenation. FF ECMO offers better CoBF than FS ECMO. Addition of IABP to FF ECMO worsens CoBF. FF ECMO, more than FS ECMO, increases CoPP over time.

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“…One hundred and ten patients had hemodynamic failure responding to conventional treatment and 17 patients had refractory shock or cardiac arrest. In our practice, patients with refractory cardiac arrest, defined as an absence of return to spontaneous circulation after continuous cardio-pulmonary resuscitation over at least 45 minutes or refractory shock, defined as shock not responding to optimal conventional treatment, were candidates for ECLS support [23]. When the decision to implant ECLS was made by a senior intensivist, a senior cardiac surgeon and a perfusionist were immediately informed and ECLS performed.…”

Section: Methodsmentioning

confidence: 99%