The Use of ECMO for the Treatment of Refractory Cardiac Arrest or Postarrest Cardiogenic Shock Following In-Hospital Cardiac Arrest: A 10-Year Experience

Chonde, Meshe; Sappington, Penny L.; Kormos, Robert L.; Althouse, Andrew D.; Boujoukos, Arthur J.

doi:10.1177/0885066617751398

Cited by 19 publications

(20 citation statements)

References 24 publications

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“…5,6 In this study, the longer the CPR duration, the less successful weaning off ECMO support after ECPR was also achieved, as like previous studies. [5][6][7][8][9][10]20 Loss of pulsatility after ECPR is the factor that we emphasized in this study. In patients with observing the loss of pulsatility, the probability of successful weaning off ECMO support after ECPR was reduced in our study.…”

Section: Discussionmentioning

confidence: 85%

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Importance of Maintaining Pulsatility after Extracorporeal Cardiopulmonary Resuscitation

Lee

Lim

Park

et al. 2020

Preprint

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Background: Recent reports have revealed better clinical outcomes with extracorporeal cardiopulmonary resuscitation (ECPR) than with conventional cardiopulmonary resuscitation (CPR) for patients with refractory cardiac arrest. This study attempted to investigate favorable predictors of pre-, intra-, and post-ECPR for successful weaning off extracorporeal membrane oxygenation (ECMO) support. Methods: We enrolled 30 ECPR patients aged over 18 years old between August 2016 and January 2019. All clinical data were retrospectively collected. The primary endpoint was that the patient was weaned off ECMO support after ECPR. Patients were divided into two groups based on successful weaning off ECMO support (Weaned vs. Failed). Results: Fourteen patients were in the weaned group. These patients were significantly younger and have shorter CPR duration than those in the failed group (p = 0.03, < 0.01). Age, CPR duration, ECMO complications and loss of pulsatility were significantly confirmed as predictive factors for successful weaning off ECMO support through univariate logistic regression analysis. However, loss of pulsatility and CPR duration remained predictors of the favorable outcome of weaning off ECMO support after ECPR by two models of multivariate logistic regression analysis. Conclusion: We conclude that CPR duration and loss of pulsatility are predictive factors of successful weaning off from ECMO support after ECPR. Loss of pulsatility relates to management during post-ECPR, unlike CPR duration. In patients with decreased pulsatility after ECPR, careful management is warranted because the loss of pulsatility is closely associated with weaning off ECMO support after ECPR.

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Section: Discussionmentioning

confidence: 85%

“…Nevertheless, ECMO has recently emerged as a major role for patients with refractory cardiac arrest. [1][2][3][4] Several researches remarked favorable predictors of clinical outcomes, [5][6][7][8] but the point of view of these studies was based on conditions before and when ECMO was applied.…”

Section: Introductionmentioning

confidence: 99%

Importance of Maintaining Pulsatility after Extracorporeal Cardiopulmonary Resuscitation

Lee

Lim

Park

et al. 2020

Preprint

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“…However, the rapid use of percutaneous mechanical circulatory support by axial flow pumps or venoarterial extracorporeal membrane oxygenation (ECMO) has the potential to improve the survival in this high-risk scenario. [27][28][29]…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcome of peri-procedural cardiogenic shock: results from the international Euro Heart Survey PCI registry

Weipert

Bauer

Nef

et al. 2019

European Heart Journal: Acute Cardiovascular Care

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Background: There is a large body of literature on acute myocardial infarction complicated by cardiogenic shock. However, very little is known about patients who are initially haemodynamically stable and develop cardiogenic shock during percutaneous coronary intervention. Methods: A total of 47,407 consecutive patients were prospectively enrolled in the PCI Registry of the Euro Heart Survey Programme. We analysed interventions with peri-procedural complications that were classified as ‘shock induced by procedure’ on the case report form. Clinical and procedural characteristics as well as hospital outcomes of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention were evaluated. Patients with haemodynamic instability at presentation prior to intervention were excluded. Results: A total of 68 patients (0.2%) developed cardiogenic shock as a complication of percutaneous coronary intervention. The majority of cases comprised acute coronary syndrome (60.3%) with complex lesions (93.1%). Most patients had multi-vessel disease (82.1%) and an ejection fraction less than 40% (58.1%). In the multivariate analysis, left main disease (odds ratio (OR) 9.51), ST-segment elevation myocardial infarction (OR 5.31) and multi-vessel disease without left main involvement (OR 3.32) were the strongest independent predictors of peri-procedural cardiogenic shock. Among these patients procedural success was low (66.1%) and in-hospital mortality was very high (39.7%). Conclusions: In this real-world registry the rate of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention was very low. Patients at a priori high risk were more likely to be affected by this complication. The in-hospital mortality rate of these patients was very high.

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“…Nevertheless, ECMO has recently emerged as a major treatment modality for patients with refractory cardiac arrest. [1][2][3][4] A small number of researches have reported favorable predictors for successful ECPR, [5][6][7][8] but their results were based on comparisons of variables before and when ECMO was applied.…”

Section: Introductionmentioning

confidence: 99%

Importance of Pulse Pressure after Extracorporeal Cardiopulmonary Resuscitation

Lee

Lim

Park

et al. 2021

Preprint

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Background: Recent reports have revealed better clinical outcomes for extracorporeal cardiopulmonary resuscitation (ECPR) than conventional cardiopulmonary resuscitation (CPR). In this retrospective study, we attempted to identify predictors associated with successful weaning off extracorporeal membrane oxygenation (ECMO) support after ECPR. Methods: The demographic and clinical data of 30 ECPR patients aged over 18 years treated between August 2016 and January 2019 were analyzed. All clinical data were retrospectively collected. The primary endpoint was successful weaning from ECMO support after ECPR. Patients were divided into two groups based on successful or unsuccessful weaning off ECMO support (Weaned (n=14) vs. Failed (n=16)). Results: Univariate logistic regression analysis showed that age, CPR duration, ECMO complications, and loss of pulse pressure significantly predicted the results of weaning off ECMO support. However, multivariate logistic regression analysis showed that only CPR duration and loss of pulse pressure independently predicted unsuccessful weaning from ECMO support. Conclusion: We conclude that long CPR duration and loss of pulse pressure after ECPR predict unsuccessful weaning from ECMO. However, unlike CPR duration, loss of pulse pressure during post-ECPR was related to subsequent management. In patients with reduced pulse pressure after ECPR, careful management is warranted because this reduction is closely associated with unsuccessful weaning off ECMO support after ECPR.

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The Use of ECMO for the Treatment of Refractory Cardiac Arrest or Postarrest Cardiogenic Shock Following In-Hospital Cardiac Arrest: A 10-Year Experience

Abstract: The use of ECMO for treatment of refractory cardiac arrest or cardiogenic shock may be a suitable treatment in a very select cohort of patients. Our results support a significantly higher 1-year survival in patients with PACS compared to refractory cardiac arrest.

Cited by 19 publications

References 24 publications

Importance of Maintaining Pulsatility after Extracorporeal Cardiopulmonary Resuscitation

Importance of Maintaining Pulsatility after Extracorporeal Cardiopulmonary Resuscitation

Incidence and outcome of peri-procedural cardiogenic shock: results from the international Euro Heart Survey PCI registry

Importance of Pulse Pressure after Extracorporeal Cardiopulmonary Resuscitation

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