Successful extracorporeal life support in cardiac arrest with recurrent ventricular fibrillation unresponsive to standard cardiopulmonary resuscitation

Shin, Jae Seung; Lee, Sung Woo; Han, Gi-Sung; Jo, Won Min; Choi, Sung Hyuk; Hong, Yun Sik

doi:10.1016/j.resuscitation.2006.09.011

Cited by 30 publications

(13 citation statements)

References 11 publications

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“…There were no published randomized controlled trials (RCTs) although two (NCT01511666 and NCT01605409) are currently enrolling patients in Prague and Vienna. 10,11 Four of the selected studies were conducted in Japan, 2 in Korea and 1 in Taiwan, [12][13][14][15][16][17][18] 5 in France, 19-23 2 in Germany 24,25 and 2 in Italy. 26,27 The remaining case series and reports were from Belgium, 28 Austria, 29 USA 30 and Australia.…”

Section: Ecpr Studiesmentioning

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%

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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: Ecpr Studiesmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

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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“…20 Dramatic survival following the use of VA ECMO during or following cardiac arrest, as occurred in our patient, has been reported. 6,11,[21][22][23][24] A 2004 ''Best-Evidence Topic Report'' suggested that 15 to 25% of selected patients who suffer witnessed cardiac arrest and are unresponsive to traditional emergency cardiac care interventions may be successfully resuscitated with ECMO, 25 and two subsequently published studies have reported similar or higher survival rates. 26,27 Historically, the initiation of VA ECMO required advanced surgical training and an operating room environment.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Abu‐Laban

Migneault

Grant

et al. 2015

CJEM

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Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed. RÉ SUMÉL'oxygé nation extracorporelle sur oxygé nateur à membrane (OEOM) est un moyen de fournir une assistance cardiaque et respiratoire temporaire à des patients gravement malades. Le rô le de l'OEOM a gagné du terrain chez certains adultes aux services des urgences (SU) au cours des derniè res anné es. Sera exposé ici le cas spectaculaire d'un homme de 29 ans, soumis à l'OEOM veino-arté rielle pour un choc cardiogé nique et une insuffisance respiratoire suivant un collapsus et un arrê t cardiaque causé par un accè s prolongé de fibrillation ventriculaire, qui est survenu au SU de l'hô pital. Les moyens de ré animation mis en oeuvre avant le dé but de l'OEOM comprenaient des manoeuvres de ré animation cardiorespiratoire (RCR) pratiqué es de faç on quasi continue durant 49 minutes; 11 tentatives de dé fibrillation; l'administration de nombreux mé dicaments, dont un thrombolytique, pendant que se poursuivaient les manoeuvres de RCR; une intervention coronarienne percutané e et la pose d'une endoprothè se pour une dissection du segment moyen de l'artè re interventriculaire anté rieure et une oblité ration thrombotique; un soutien inotrope et la contrepulsion par ballon intra-aortique. Au cours des 48 heures suivant le dé but de l'OEOM, l'é tat cardiorespiratoire du patient s'est amé lioré rapidement, et celui-ci est retourné chez lui 9 jours aprè s son admission, et ce, sans souffrir de sé quelles neurologiques. Seront passé s en revue l'historique, les indications et le rô le de plus en plus grand de l'OEOM dans diverses affections, dont l'arrê t cardiaque.

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“…In case of cardiogenic shock the heart is at a full stop, The normal procedure is to first try to resuscitate the patient with cardiopulmonary resuscitation, however when this procedure is not effective a portable heart lung machine or extracorporeal circulatory support system may be used. Previous research has shown that continuous tries of CPR may bring greater complications and reduce the possibility of survival [21]. With the use of an ECSS the heart may remain inactive while the rest of the body may be adequately perfused.…”

Section: 1a Evolution Of the Hlmmentioning

confidence: 99%

Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers

García

Krane

Baumgartner

et al. 2014

Medical Engineering & Physics

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ZusammenfassungDie frühe Behandlung mit Extrakorporalen Kreislauf-Unterstützungssystemen bei Patienten mit kardiogenem Schock wirkt sich positiv auf den weiteren Verlauf aus und kann einem Multi-Organversagen entgegenwirken. Um eine frühe Behandlung zu ermöglichen, ist eine kontinuierlicheÜberwachung des Patienten durch geschulte Kardiotechniker notwendig. Unter Notfallbedingungen kann eine ungeteilte Aufmerksamkeit für den Patienten nicht garantiert werden womit es zu Behandlungsfehlern kommen kann.Durch AbstractPatients suffering from cardiogenic shock may benefit with an early application of a portable Extracorporeal Circulatory Support System (ECSS) preventing multi organ failure. This however requires the presence and constant supervision of the patient by trained personal at the emergency site. Under these circumstances full attention to the patient may not be guaranteed and operation errors may occur.With the automation of the portable ECSS optimal perfusion may be achieved with minimal workload for the human operator allowing the safe transportation of the patient to the hospital.The focus of this thesis is the development of an adaptive and robust control system that regulates perfusion based on online data of the patient. While the system needs to be highly dynamic, so that it is able to adapt to different situations, it must ensure maximal patient safety at all times.To develop such control system first an animal model was used to analyze the type of signals acquired during extracorporeal circulation. This information was used as a reference for the creation of a mathematical model. The model includes a cardiovascular system undergoing extracorporeal circulation, a gas exchange model and a medication model. This was integrated into a simulation system that could be used for the creation and evaluation of the designed controller.Fuzzy logic was considered as a control mechanism allowing the easy creation of rules based on the knowledge of trained perfusionists. Since patient pre-conditions and reactions will be different from one case to another an adaptive mechanism is proposed to modify the existing controller and adapt to the specific needs of the patient.A software framework was developed allowing a fast implementation of the control system. This framework was created not only focusing on the automation of the ECSS but also to serve as a basis for the development of control systems for other medical devices with similar requirements.Several simulations are presented showing the performance of the fuzzy controller with the proposed adaptive mechanism. Additional simulations show the response of the designed ECSS controller under different patient scenarios.vii Acknowledgments I want to give thanks to my advisor Prof. Dr. Alois Knoll for giving me the opportunity of working in this thesis, for his support and confidence. I would also like to thank Prof. Dr. Robert Bauernschmitt for taking the time to review my work and acting as a second advisor. From the department of Robotics and Embedded Systems ...

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Successful extracorporeal life support in cardiac arrest with recurrent ventricular fibrillation unresponsive to standard cardiopulmonary resuscitation

Cited by 30 publications

References 11 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

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers

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