Traumatic and hemorrhagic complications after extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Nguyen, My-Linh; Gause, Emma; Mills, Brianna; Tonna, Joseph E.; Alvey, Heidi; Saczkowski, Richard; Grunau, Brian; Becker, Lance B.; Gaieski, David F.; Youngquist, Scott T.; Gunnerson, Kyle J.; England, Peter; Hamilton, Jessica; Badulak, Jenelle; Mandell, Samuel P.; Bulger, Eileen M.; Johnson, Nicholas J.

doi:10.1016/j.resuscitation.2020.09.035

Cited by 31 publications

(14 citation statements)

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“…Multiple pathological processes such as autoantibody and complement activation, no-reflow-phenomena, vascular leakage and cell death programs are triggered by uncontrolled reperfusion after ischemia [ 29 , 30 ]. As the use of extracorporeal circulation devices can trigger similar complications [ 10 – 12 ] and in prolonged resuscitation encounters an already damaged organism, we aimed to provide a closer examination of these processes.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, ECPR has already been implemented in international resuscitation guidelines [ 8 , 9 ]. However, the use of extracorporeal circulation devices is associated with various complications, such as increased hemolysis, increased bleeding propensity and activation of inflammatory pathways [ 10 – 12 ]. Each of these complications on its own has the potential to promote cell death and to negatively affect the outcome of a prolonged resuscitation [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Serum proteome alterations during conventional and extracorporeal resuscitation in pigs

et al. 2022

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Background Only a small number of patients survive an out-of-hospital cardiac arrest (CA) and can be discharged from hospital alive with a large percentage of these patients retaining neurological impairments. In recent years, extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a beneficial strategy to optimize cardiac arrest treatment. However, ECPR is still associated with various complications. To reduce these problems, a profound understanding of the underlying mechanisms is required. This study aims to investigate the effects of CA, conventional cardiopulmonary resuscitation (CPR) and ECPR using a whole-body reperfusion protocol (controlled and automated reperfusion of the whole body—CARL) on the serum proteome profiles in a pig model of refractory CA. Methods N = 7 pigs underwent 5 min of untreated CA followed by 30 min CPR and 120 min perfusion with CARL. Blood samples for proteomic analysis were drawn at baseline, after CPR and at the end of the CARL period. Following albumin-depletion, proteomic analysis was performed using liquid chromatography–tandem mass spectrometry. Results N = 21 serum samples were measured resulting in the identification and quantification of 308–360 proteins per sample and 388 unique proteins in total. The three serum proteome profiles at the investigated time points clustered individually and segregated almost completely when considering a 90% confidence interval. Differential expression analysis showed significant abundance changes in 27 proteins between baseline and after CPR and in 9 proteins after CARL compared to CPR. Significant findings were further validated through a co-abundance cluster analysis corroborating the observed abundance changes. Conclusions The presented data highlight the impact of systemic ischemia and reperfusion on the entire serum proteome during resuscitation with a special focus on changes regarding haemolysis, coagulation, inflammation, and cell-death processes. Generally, the observed changes contribute to post-ischemic complications. Better understanding of the underlying mechanisms during CA and resuscitation may help to limit these complications and improve therapeutic options.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum proteome alterations during conventional and extracorporeal resuscitation in pigs

et al. 2022

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“…Indirect risks, such as cost and resource utilization, must also be considered. Hospital length of stay is variable, 51 influenced in aggregate by early withdrawal of care 31 and the burden of comorbid injuries sustained 49,51 . In the ARREST trial, this includes an average of 10 days to extubation, 22 days in the intensive care unit, and 26 days total in the hospital.…”

Section: Risks and Benefitsmentioning

confidence: 99%

“…Additionally, there is the possibility of clot formation and systemic embolization within the extracorporeal circuit, which can impede blood flow to vital organs. Furthermore, ECPR patients can experience multisystem organ failure from prolonged hypoperfusion in addition to the trauma from external chest compressions 47–49 . Neurologic injury is also a common life‐limiting problem, 50 requiring early and ongoing neuroprognostication.…”

Section: Risks and Benefitsmentioning

confidence: 99%

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life‐saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.

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“…Unfortunately, data are limited on the value of diagnostic CT in ECPR patients. One study showed that CT can identify injuries that may have precipitated the arrest (e.g., aortic dissection), as well as traumatic complications from the resuscitation (e.g., pneumothorax, fractures) and from cannulation (e.g., cannulation site bleeding, vascular injury) (68). There are also good data from patients with OHCA who achieve ROSC without ECPR that describe the prevalence and distribution of conditions and injuries among resuscitated OHCA patients when imaged with “full body” CT (21, 69), reinforcing the high prevalence of injuries and the value of comprehensive postarrest diagnostic imaging.…”

Section: Imagingmentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation

Tonna,

Cho

2024

Critical Care Medicine

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Traumatic and hemorrhagic complications after extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Cited by 31 publications

References 18 publications

Serum proteome alterations during conventional and extracorporeal resuscitation in pigs

Serum proteome alterations during conventional and extracorporeal resuscitation in pigs

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Extracorporeal Cardiopulmonary Resuscitation

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