Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis

Chen, Yih‐Sharng; Lin, Jou‐Wei; Yu, Hsi‐Yu; Ko, Wen‐Je; Jerng, Jih-Shuin; Chang, Wei‐Tien; Chen, Wen‐Jone; Huang, Shu‐Chien; Chi, Nai‐Hsin; Wang, Chih‐Hsien; Chen, Li-Chin; Tsai, Pi‐Ru; Wang, Shoei‐Shen; Hwang, Juey‐Jen; Lin, Fang‐Yue

doi:10.1016/s0140-6736(08)60958-7

Cited by 1,010 publications

(816 citation statements)

References 29 publications

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“…This leads to limitations as to when E-CPR can be performed due to variable availability of attending physicians, perfusionists and ECMO circuits. This is a setting that differs from that described in a number of previous reports on E-CPR [8][9][10]. Ideally, our E-CPR sample could have been compared to an internal control group, but our hospital CPR records are incompletely documented, and the CPR patient population differed from ours.…”

Section: Discussionmentioning

confidence: 89%

“…Further studies on E-CPR have shown an increased rate of survival at 1-year [8], and 2-years [9] after discharge when compared to conventional CPR. Many of these studies on adult E-CPR have taken place under optimal conditions in institutions that have designated teams of E-CPR specialists, ready to cannulate patients as a part of the Code Team [8][9][10].…”

Section: Introductionmentioning

confidence: 98%

“…In a study that assessed the survival benefits of E-CPR compared to conventional CPR after a witnessed arrest, E-CPR provided a significantly higher return of spontaneous circulation, and a ~ 20% increase in survival rate at discharge [8]. Further studies on E-CPR have shown an increased rate of survival at 1-year [8], and 2-years [9] after discharge when compared to conventional CPR.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…[14][15][16][17] In this study, the PS was the conditional probability for getting ACE inhibitors, as a binary-dependent variable, under a set of measurements. Clinical risk factors, such as sex, age, hypertension, diabetes, left ventricular mass, medication use, coronary artery disease, blood creatinine levels, the number of diseased coronary arteries, previous myocardial infarction, hemoglobin levels, dyslipidemia, severity of valvular heart disease, genetic polymorphisms, and medication history in addition to ACE inhibitors were added into a nonparsimonious multivariable logistic regression model to predict the predilection for the use of ACE inhibitors.…”

Section: Ps-based Matchingmentioning

confidence: 99%

Demonstrating the pharmacogenetic effects of angiotensin-converting enzyme inhibitors on long-term prognosis of diastolic heart failure

Jl²,

Tsai

et al. 2009

Pharmacogenomics J

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The objective of this study was to evaluate the effects of angiotensin-converting enzyme (ACE) inhibitors and pharmacogenetic interaction on the survival of the patients with diastolic heart failure (DHF). A total of 285 subjects with DHF confirmed by echocardiography were recruited in the period between 1995 and 2003. Baseline characteristics (age, sex, prior history, medication, and echocardiographic findings) and genetic polymorphisms (ACE gene insertion/ deletion (I/D) polymorphism; T174M, M235T, G-6A, A-20C, G-152A, and G-217A polymorphisms of the angiotensinogen (AGT) gene; and A1166C polymorphisms of the angiotensin II type I receptor (AT1R)) were collected and matched (by propensity score) in those who received and those who did not receive ACE inhibitors. The patients were followed up to 10 years. Kaplan-Meier curves and Cox regression models were used to demonstrate the survival trend. The 85 patients who received ACE inhibitors and the other 85 patients who did not were found to have comparable baseline characteristics and polymorphism distribution. Prescription of ACE inhibitors was associated with a significant decrease in overall mortality (hazard ratio (HR), 0.45; 95% confidence interval (CI), 0.24-0.83; P ¼ 0.01), and a lower rate of cardiovascular events at 4000 days (HR, 0.53; 95% CI, 0.32-0.90; P ¼ 0.02). In addition, ACE I/D gene D allele was associated with higher overall mortality as compared with the I allele (HR, 2.04; P ¼ 0.003). This effect was diminished in those who received ACE inhibitors. The use of ACE inhibitor was associated with a significant decrease in long-term mortality and cardiovascular events in the patients with DHF. Genetic variants in the renin-angiotensin system genes were also associated, but their effects could be modified by the use of ACE inhibitors.

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“…A prospective study that compared patients with external CPR with patients who received VA-ECMO after 10 minutes of external CPR found a survival benefit with the use of VA-ECMO. 3 Survival is poor in older patients and in cases in which VA-ECMO is initiated after more than 30 minutes of CPR. 4 Postreperfusion cardiac arrest during liver transplantation may be well suited for rescue VA-ECMO and potentially better than external CPR.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation

Tejani

Eudailey

et al. 2015

Liver Transpl

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TO THE EDITORS:Intraoperative cardiac arrest is a dreaded complication of liver transplantation with a poor outcome. 1,2 The majority of cardiac arrests occur during the neohepatic phase, especially during reperfusion, and most are caused by either postreperfusion syndrome or pulmonary thromboembolic events. 2 Almost 20% of patients with intraoperative cardiac arrest cannot be successfully resuscitated and do not regain a spontaneous rhythm and circulation. Of those who regain a spontaneous rhythm and circulation with cardiopulmonary resuscitation (CPR), more than 12% will not survive the surgery. The mortality of intraoperative cardiac arrest increases exponentially with the duration of CPR. If spontaneous rhythm and circulation are not restored rapidly, the prognosis is usually poor. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as an extension of CPR in many clinical scenarios with varying success. We describe a successful case of the use of VA-ECMO to treat postreperfusion cardiac arrest and discuss practical aspects of using VA-ECMO as rescue CPR during liver transplantation. CASE REPORTA 61-year-old man with hepatitis B cirrhosis and hepatocellular carcinoma underwent deceased donor liver transplantation. He had previously undergone transarterial chemoembolization of the hepatocellular carcinoma and esophageal banding for esophageal varices. His physiologic Model for End-Stage Liver Disease score was 8 (serum creatinine 5 0.66 mg/dL, total bilirubin 5 0.9 mg/dL, and international normalized ratio 5 1.2). He was well compensated and reported good exercise tolerance with no symptoms of cardiac disease. A transthoracic echocardiogram 3 months before surgery demonstrated a left ventricular ejection fraction of 60% to 65%, normal biventricular systolic function, and no valvular pathologies. There was no evidence of wall motion abnormalities on a technetium-99m sestamibi pharmacologic stress test, which was also performed 3 months before surgery.A suitable standard criteria donor organ was identified (a 25-year-old woman who had a subarachnoid hemorrhage). The liver graft was procured and coldpreserved in a standard fashion without a perfusion circuit. The cold ischemia time of the graft was 5 hours 15 minutes, and the warm ischemia time was 47 minutes.The recipient was brought into the operating room, and after induction of general anesthesia, left radial and right femoral arterial catheters were placed along with a right internal jugular introducer with a pulmonary artery catheter without any complications. Initial intraoperative laboratory values were unremarkable. The dissection phase proceeded without complications and without the need for blood products. The patient tolerated clamping of the inferior vena cava and removal of the native liver with only low-dose vasopressor support (norepinephrine at 1 mg/minute and vasopressin at 1 U/hour). During the anhepatic phase, the patient remained hemodynamically stable and required slowly increasing doses of vasopressors with peak doses o...

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Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis

Cited by 1,010 publications

References 29 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

Demonstrating the pharmacogenetic effects of angiotensin-converting enzyme inhibitors on long-term prognosis of diastolic heart failure

Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation

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