Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest

Lamhaut, Lionel; Jouffroy, Romain; Soldán, M. Mateo Paz; Phillipe, Pascal; Deluze, Thibaut; Jaffry, Murielle; Dagron, C.; Vivien, Benoît; Spaulding, Christian; An, Ke; Carli, Pierre

doi:10.1016/j.resuscitation.2013.06.003

Cited by 143 publications

(90 citation statements)

References 19 publications

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“…While there was some variability in time points of reported outcomes, the overall reported survival rate was 22%, including 13% having a good neurological recovery (CPC 1-2 or GOS 4-5, see Table 1). In addition to these short-term results, three studies 12,13,19 reported patient outcomes at 3 months with an overall survival rate of 21% (24/115), including 15% (17/115) having good neurological function and five studies 16,20,22,26,30 reported patient outcomes at 6 months with an overall survival rate of 16% (61/377), including 9% (34/377) having good neurological function.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies 19,23,26 reported on potential organ donors from the group of non-survivors with anoxic brain injury, including donation after brain death (DBD) and controlled donation after circulatory determination of death (cDCD). After contacting all authors, data on organ donation outcomes were provided from 5 additional studies 13,14,27,28,31 (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…The main exclusion criteria were the pre-existence of severe comorbidities, neurological disabilities, a valid do not attempt resuscitation order and the identification of a primary non-cardiac etiology (Table 2). • Catheter Lab + IABP: 1 study 17 • Catheter Lab + IABP + TTM: 9 studies [13][14][15][16][18][19][20]26,27 CPR, cardiopulmonary resuscitation; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; TTM, targeted temperature management, also known as therapeutic mild hypothermia; IABP, intra-aortic balloon pump.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…19,21 Followed by a variable door-to-cannulation period of time, the bundle treatment approach included coronary revascularization in the catheterization lab, and in some studies adjunctive therapies were also deployed ( Table 2). These co-interventions were targeted temperature management (TTM) for neurological protection and/or the use of an intra-aortic balloon pump (IABP).…”

Section: Ecpr Processmentioning

confidence: 99%

See 3 more Smart Citations

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Shapiro

Josephson

Rosenfeld³

et al. 2017

Annals ATS

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a b s t r a c tAim: Extracorporeal resuscitation during cardiopulmonary resuscitation (ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated circulation until the return of spontaneous circulation (ROSC). The purpose of this systematic review is to address the defining elements and outcomes (quality survival and organ donation) of currently active protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of cardiac origin in adult patients. The results may inform policy and practices for ECPR and help clarify the corrresponding intersection with deceased organ donation. Methods: We searched Medline, Embase, Cochrane and seven other electronic databases from 2005 to 2015, with no language restrictions. Internal validity and the quality of the studies reporting outcomes and guidelines were assessed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015259). Results: One guideline and 20 outcome studies were analyzed. Half of the studies were prospective observational studies assessed to be of fair to good methodological quality. The remainder were retrospective cohorts, case series, and case studies. Ages ranged from 16 to 75 years and initial shockable cardiac rhythms, witnessed events, and a reversible primary cause of cardiac arrest were considered favorable prognostic factors. CPR duration and time to hospital cannulation varied considerably. Coronary revascularization, hemodynamic interventions and targeted temperature management neuroprotection were variable. A total of 833 patients receiving this ECPR approach had an overall reported survival rate of Abbreviations: ECPR, extracorporeal resuscitation; ROSC, return of spontaneous circulation; OHCA, out-of-hospital cardiac arrest; CPC, cerebral performance category; GOS, Glasgow Outcome Scale; LOE, level of evidence; ILCOR, International Liaison Committee on Resuscitation; RCTs, randomized controlled trials; TTM, targeted temperature management; IABP, intra-aortic balloon pump; DBD, donation after brain death; cDCD, controlled donation after circulatory determination of death; ELSO, extracorporeal life support organization. I. Ortega-Deballon et al. / Resuscitation 101 (2016) 12-20 13 22%, including 13% with good neurological recovery. Additionally, 88 potential and 17 actual deceased organ donors were identified among the non-survivor population in 8 out of 20 included studies. Study heterogeneity precluded a meta-analysis preventing any meaningful comparison between protocols, interventions and outcomes. Conclusions: ECPR is feasible for refractory OHCA of cardiac origin in adult patients. It may enable neurologically good survival in selected patients, who practically have no other alternative in order to save their lives with quality of life, and contribute to organ donation in those who die. Large, prospective studies are required to clarify patient selection, modifiable outcome variables, risk-benefit and cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

Section: Ecpr Processmentioning

confidence: 99%

See 2 more Smart Citations

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Shapiro

Josephson

Rosenfeld³

et al. 2017

Annals ATS

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“…In addition, this SOP needs validation in the clinical setting. As the field evolves, this SOP may need updating as more evidence becomes available in emerging areas, such as the use of extra corporeal life support 26 .…”

Section: Resultsmentioning

confidence: 99%

Pediatric Drowning

et al. 2017

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Objectives Drowning is one of the leading causes of death in children. Resuscitating a child following submersion is a high-pressure situation, and standard operating procedures can reduce error. Currently, the Resuscitation Council UK guidance does not include a standard operating procedure on pediatric drowning. The objective of this project was to design a standard operating procedure to improve outcomes of drowned children. Methods A literature review on the management of pediatric drowning was conducted. Relevant publications were used to develop a standard operating procedure for management of pediatric drowning. Results A concise standard operating procedure was developed for resuscitation following pediatric submersion. Specific recommendations include the following: the Heimlich maneuver should not be used in this context; however, prolonged resuscitation and therapeutic hypothermia are recommended. Conclusions This standard operating procedure is a potentially useful adjunct to the Resuscitation Council UK guidance and should be considered for incorporation into its next iteration.

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Systematic review to assess the possibility of return of cerebral and cardiac activity after normothermic regional perfusion for donors after circulatory death

Shapey

Summers

Augustine

et al. 2019

British Journal of Surgery

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Background Normothermic regional perfusion (NRP) is a novel technique that aids organ recovery from donors after circulatory death (DCDs). However, ethical concerns exist regarding the potential return of spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to determine the likelihood of ROSCCA in NRP‐DCDs of abdominal organs. Methods Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out‐of‐hospital cardiac arrest (OOHCA) was identified as a comparator for NRP‐DCDs and as a validation cohort. A systematic search identified all articles relating to NRP‐DCDs and ECPR‐OOHCA. Rates of ROSCCA and survival outcomes (ECPR‐OOHCA only) were recorded and analysed according to the duration of no perfusion. Results In NRP‐DCDs, 12 of 410 articles identified by database searching were eligible for inclusion. There were no instances of ROSCCA recorded among 493 donors. In ECPR‐OOHCA, eight of 947 screened articles were eligible for inclusion (254 patients). Where the absence of perfusion exceeded 5 min in ECPR‐OOHCA, there were no survivors with a favourable neurological outcome. Conclusion ROSCCA is unlikely following commencement of NRP and has not occurred to date. Strict observance of the 5‐min interval following asystole provides satisfactory assurance that ROSCCA will not occur following NRP.

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Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest

Cited by 143 publications

References 19 publications

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Pediatric Drowning

Systematic review to assess the possibility of return of cerebral and cardiac activity after normothermic regional perfusion for donors after circulatory death

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