A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest

Haneya, Assad; Philipp, Alois; Diez, Claudius; Schopka, Simon; Bein, Thomas; Zimmermann, Markus; Lubnow, Matthias; Luchner, Andreas; Agha, Ayman; Hilker, Michael; Hirt, Stephan; Schmid, Çhristof; Müller, Thomas

doi:10.1016/j.resuscitation.2012.07.009

Cited by 180 publications

(152 citation statements)

References 34 publications

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“…Our study also partially agrees with major conclusions from previous studies of adult E-CPR patients, which indicate that a state of acidosis is correlated with poor E-CPR outcomes [20]. However, our results contradicted the findings of a number of other studies, including those which claimed that low inotrope levels, low pre-ECMO lactate levels, shorter CPR duration, and low pre-ECMO SOFA scores were associated with favorable outcomes in E-CPR patients [17][18][19].…”

Section: Discussionsupporting

confidence: 88%

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Peigh

Cavarocchi

Hirose

2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionsupporting

confidence: 88%

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Peigh

Cavarocchi

Hirose

2015

The Journal of Thoracic and Cardiovascular Surgery

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“…Most of the included studies presented high risk of confounding bias and threats to external validity because of their observational design. However, the methodological quality assessment of the 20 included studies resulted in a rating of good for 14 studies [12][13][14][15][16]18,20,[22][23][24][25][26][27][28] and fair for the other 6 17,19,21,29-31 (see Table 1). …”

Section: Ecpr Studiesmentioning

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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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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“…Several studies have reported the number of patients treated with individual ECPR protocols, with patients included at the discretion of treating clinicians; 5,6,[21][22][23][24][25][26] however, the denominator and outcomes of potentially eligible patients within these regions is unknown. Poppe and colleagues examined a cohort of OHCA cases, and applied the following criteria for which paramedics should "load [the patient] and go" to hospital for ECPR management: adult patients < 75 years old with a witnessed arrest, bystander CPR performed, an initial shockable rhythm, and no sustained return of spontaneous circulation (ROSC) within 15 minutes of EMS resuscitation.…”

Section: Potential Candidates For Canadian Ecpr Program For Ohcamentioning

confidence: 99%

“…5,21,23 For this reason and based on established practice, 7 we limited our hypothetical ECPR treatment catchment to our health region, for which the transport times for an ambulance to an ECPR-capable centre would be approximately 20 minutes or less. Although population density and demographics will vary, the time-dependent nature of ECPR therapy will likely limit the volume of ECPR programs in other regions to similar quantities.…”

Section: Potential Candidates For Canadian Ecpr Program For Ohcamentioning

confidence: 99%

“…Although some ECPR protocols have focused solely on patients with initial shockable rhythms, 7,28 other protocols have shown promising results in nonshockable patients, reporting survival to discharge in 29%-35% 6,7,21 . It is unclear whether the benefit of ECPR therapy for those with initial non-shockable rhythms differs from those with initial shockable rhythms.…”

Section: Potential Candidates For Canadian Ecpr Program For Ohcamentioning

confidence: 99%

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Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Grunau

Scheuermeyer

Stub

et al. 2016

CJEM

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Objective: Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. Methods: We performed a secondary analysis from a 52-month prospective registry of consecutive adult nontraumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge. Results: Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge. Conclusion: In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes. RÉSUMÉObjectif: La réanimation cardiorespiratoire extracorporelle (RCREC), bien qu'elle soit exigeante sur le plan des ressources, peut améliorer les résultats cliniques chez certains patients ayant subi un arrêt cardiaque extrahospitalier (ACEH) réfrac-taire. Les auteurs de l'étude cherchaient à déterminer les patients qui répondaient aux un ensemble de critères de la RCREC afin d'estimer, d'une part, la proportion de patients ayant subi un arrêt cardiaque réfractaire qui auraient pu profiter de la méthode de réanimation et, d'autre part, les résultats cliniques obtenus par la méthode habituelle de réanimation. Méthode: Les auteurs ont procédé à une analyse secondaire d'un registre prospectif, constitué de cas consécutifs d'ACEH non traumatique, survenus chez des adultes, sur une période de 52 mois, dans une seule région sanitaire urbaine d'un million de personnes, au Canada. Les auteurs ont formé une cohorte fictive d'adultes, âgés de moins de 60 ans, susceptibles d'être traités par la RCREC après avoir subi un ACEH devant des témoins et avoir fait l'objet de manoeuvres de réanimation cardiorespiratoire par des passants ou avoir reçu des soins donnés par des services médicaux d'urgence (SMU), et ce, en l'espace de cinq minutes. Le principal critère d'éval...

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A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest

Cited by 180 publications

References 34 publications

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

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

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

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