Association of chest compression pause duration prior to E-CPR cannulation with cardiac arrest survival outcomes

Lauridsen, Kasper Glerup; Lasa, Javier J.; Raymond, Tia; Yu, Priscilla; Niles, Dana; Sutton, Robert M.; Morgan, Ryan W.; Hazinski, Mary Fran; Griffis, Heather; Hanna, Richard; Zhang, Xuemei; Berg, Robert A.

doi:10.1016/j.resuscitation.2022.05.004

Cited by 12 publications

(15 citation statements)

References 41 publications

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“…Another limitation toward clinical relevance is that wires were placed in the internal jugular vein and internal carotid artery before the initiation of CPR; this allowed for consistent cannulation times within groups (Table S5 ), which were desired to decrease confounding and minimize the variability of the pericannulation “no‐flow.” Our study protocol also used standardized, brief interruptions in chest compressions during cannulation (30‐second pause followed by 60 seconds of chest compressions) to minimize confounding variability. Although it is possible to keep chest compression fraction >80% during the past 5 minutes of CPR before ECPR cannulation, 53 there is more variation clinically in terms of chest compression mechanics and interruptions, 54 and this should be a future objective of clinical research. There was a lack of left ventricular unloading and the likely development of pulmonary congestion and edema, which could have been ameliorated clinically.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Extracorporeal Cardiopulmonary Resuscitation: Development of a Porcine Model and the Influence of Cardiopulmonary Resuscitation Duration on Brain Injury

Slovis

Volk

Mavroudis

et al. 2023

JAHA

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Background The primary objective was to develop a porcine model of prolonged (30 or 60 minutes) pediatric cardiopulmonary resuscitation (CPR) followed by 22‐ to 24‐hour survival with extracorporeal life support, and secondarily to evaluate differences in neurologic injury. Methods and Results Ten‐kilogram, 4‐week‐old female piglets were used. First, model development established the technique (n=8). Then, a pilot study was conducted (n=15). After 80% survival was achieved in the final 5 pilot animals, a proof‐of‐concept randomized study was completed (n=11). Shams (n=6) underwent anesthesia only. Severe neurological injury was determined by a composite score of mitochondrial function, neuropathology, and cerebral metabolism: scale of 0–6 (severe: >3). Among 15 piglets in the pilot study, overall survival was 10 (67%); of the final 5, overall survival was 4 (80%). Eleven piglets were then randomized to 60 (CPR60, n=5) or 30 minutes of CPR (CPR30, n=5); 1 animal was excluded from prerandomization for intra‐abdominal hemorrhage (10/11, 91% survival). Three of 5 animals in the CPR60 group had severe neurological injury scores versus 1 of 5 in the CPR30 group ( P =0.52). During ECMO, CPR60 animals had lower pH (CPR60: 7.4 [IQR 7.4–7.4] versus CPR30: 7.5 [IQR 7.4–7.5], P =0.022), higher lactate (CPR60: 6.8 [IQR 6.8–11] versus CPR30: 4.2 [IQR 4.1–4.3] mmol/L; P =0.012), and higher ICP (CPR60: 19.3 [IQR 11.7–29.3] versus CPR30: 7.9 [IQR 6.7–9.3] mm Hg; P =0.037). Both groups had greater mitochondrial injury than shams (CPR60: P <0.001; CPR30: P <0.001). CPR60 did not differ from CPR30 in mitochondrial respiration, neuropathology, or cerebral metabolism. Conclusions A pediatric porcine model of extracorporeal cardiopulmonary resuscitation after 60 and 30 minutes of CPR consistently resulted in 24‐hour survival with more severe lactic acidosis in the 60‐minute cohort.

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Section: Discussionmentioning

confidence: 99%

Pediatric Extracorporeal Cardiopulmonary Resuscitation: Development of a Porcine Model and the Influence of Cardiopulmonary Resuscitation Duration on Brain Injury

Slovis

Volk

Mavroudis

et al. 2023

JAHA

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“…Sixth, ECMO complication data are not recorded in the GWTG-R database, limiting the details of our survival outcomes. Finally, given limitations of data availability, we could not incorporate CPR mechanics into our interpretation of outcomes (39, 40). Given these limitations introduced through the use of retrospective data, there continues to be a need for prospective studies of ECPR in this population; whether equipoise exists for randomized controlled trials of ECPR vs. CCPR should be explored.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest Among Children With Noncardiac Illness Categories*

Loaec,

Himebauch,

Reeder

et al. 2023

Critical Care Medicine

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Objectives: The objective of this study was to determine the association of the use of extracorporeal cardiopulmonary resuscitation (ECPR) with survival to hospital discharge in pediatric patients with a noncardiac illness category. A secondary objective was to report on trends in ECPR usage in this population for 20 years. Design: Retrospective multicenter cohort study. Setting: Hospitals contributing data to the American Heart Association’s Get With The Guidelines-Resuscitation registry between 2000 and 2021. Patients: Children (<18 yr) with noncardiac illness category who received greater than or equal to 30 minutes of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest. Interventions: None. Measurements and Main Results: Propensity score weighting balanced ECPR and conventional CPR (CCPR) groups on hospital and patient characteristics. Multivariable logistic regression incorporating these scores tested the association of ECPR with survival to discharge. A Bayesian logistic regression model estimated the probability of a positive effect from ECPR. A secondary analysis explored temporal trends in ECPR utilization. Of 875 patients, 159 received ECPR and 716 received CCPR. The median age was 1.0 [interquartile range: 0.2–7.0] year. Most patients (597/875; 68%) had a primary diagnosis of respiratory insufficiency. Median CPR duration was 45 [35–63] minutes. ECPR use increased over time (p < 0.001). We did not identify differences in survival to discharge between the ECPR group (21.4%) and the CCPR group (16.2%) in univariable analysis (p = 0.13) or propensity-weighted multivariable logistic regression (adjusted odds ratio 1.42 [95% CI, 0.84–2.40; p = 0.19]). The Bayesian model estimated an 85.1% posterior probability of a positive effect of ECPR on survival to discharge. Conclusions: ECPR usage increased substantially for the last 20 years. We failed to identify a significant association between ECPR and survival to hospital discharge, although a post hoc Bayesian analysis suggested a survival benefit (85% posterior probability).

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“…A small number of patients had 20 minutes of hemodynamic data collection, which was still less than half the median arrest duration of 43 minutes. Thus, we did not have hemodynamics during ECPR cannulation for the majority of patients, and so we could not analyze the CCF at the time of cannulation and duration/frequency of pauses in resuscitation for cannulation, which has been associated with worse outcomes (11, 17). Additionally, technical details of cannulation (i.e., cannulation site, cannula sizes, and configuration) and surgeon skill were an unmeasured, but potentially important, factor for the outcomes of interest (7).…”

Section: Discussionmentioning

confidence: 99%

Early Cardiac Arrest Hemodynamics, End-Tidal Co 2, and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016–2021)*

Yates,

Naim,

Reeder

et al. 2023

Pediatric Critical Care Medicine

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Objectives: Cannulation for extracorporeal membrane oxygenation during active extracorporeal cardiopulmonary resuscitation (ECPR) is a method to rescue patients refractory to standard resuscitation. We hypothesized that early arrest hemodynamics and end-tidal Co 2 (ETco 2) are associated with survival to hospital discharge with favorable neurologic outcome in pediatric ECPR patients. Design: Preplanned, secondary analysis of pediatric Utstein, hemodynamic, and ventilatory data in ECPR patients collected during the 2016–2021 Improving Outcomes from Pediatric Cardiac Arrest study; the ICU-RESUScitation Project (ICU-RESUS; NCT02837497). Setting: Eighteen ICUs participated in ICU-RESUS. Patients: There were 97 ECPR patients with hemodynamic waveforms during cardiopulmonary resuscitation. Interventions: None. Measurements and Main Results: Overall, 71 of 97 patients (73%) were younger than 1 year old, 82 of 97 (85%) had congenital heart disease, and 62 of 97 (64%) were postoperative cardiac surgical patients. Forty of 97 patients (41%) survived with favorable neurologic outcome. We failed to find differences in diastolic or systolic blood pressure, proportion achieving age-based target diastolic or systolic blood pressure, or chest compression rate during the initial 10 minutes of CPR between patients who survived with favorable neurologic outcome and those who did not. Thirty-five patients had ETco 2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ETco 2 less than 10 mm Hg and two (12%) had a maximum ETco 2 less than 10 mm Hg during the initial 10 minutes of resuscitation. Conclusions: We did not identify an association between early hemodynamics achieved by high-quality CPR and survival to hospital discharge with favorable neurologic outcome after pediatric ECPR. Candidates for ECPR with ETco 2 less than 10 mm Hg may survive with favorable neurologic outcome.

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Association of chest compression pause duration prior to E-CPR cannulation with cardiac arrest survival outcomes

Cited by 12 publications

References 41 publications

Pediatric Extracorporeal Cardiopulmonary Resuscitation: Development of a Porcine Model and the Influence of Cardiopulmonary Resuscitation Duration on Brain Injury

Pediatric Extracorporeal Cardiopulmonary Resuscitation: Development of a Porcine Model and the Influence of Cardiopulmonary Resuscitation Duration on Brain Injury

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest Among Children With Noncardiac Illness Categories*

Early Cardiac Arrest Hemodynamics, End-Tidal Co 2, and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016–2021)*

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