ECPR for out-of-hospital cardiac arrest: more evidence is needed

MacLaren, Graeme; Masoumi, Amirali; Brodie, Daniel

doi:10.1186/s13054-019-2722-0

Cited by 38 publications

(26 citation statements)

References 14 publications

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“…Sixth, although ECPR is expected to be beneficial as a last resort to save patients with refractory VF, the method has not been assessed by randomized clinical trials, and it remains controversial. 2 , 4 , 5 , 35 , 36 , 37 It must be noted that the utility of the score is based on the assumption that ECPR is effective among patients with refractory OHCA. Further prospective research is needed to evaluate the utility and validity of our scoring system in other clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Clinical Score to Predict Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

et al. 2020

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IMPORTANCE Extracorporeal cardiopulmonary resuscitation (ECPR) is expected to improve the neurological outcomes of patients with refractory cardiac arrest; however, it is invasive, expensive, and requires substantial human resources. The ability to predict neurological outcomes would assist in patient selection for ECPR. OBJECTIVE To develop and validate a prediction model for neurological outcomes of patients with out-of-hospital cardiac arrest with shockable rhythm treated with ECPR. DESIGN, SETTING, AND PARTICIPANTS This prognostic study analyzed data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a multi-institutional nationwide cohort study that included 87 emergency departments in Japan. All adult patients with out-of-hospital cardiac arrest and shockable rhythm who were treated with ECPR between June 2014 and December 2017 were included. Patients were randomly assigned to the development and validation cohorts based on the institutions. The analysis was conducted between November 2019 and August 2020. EXPOSURES Age (<65 years), time from call to hospital arrival (Յ25 minutes), initial cardiac rhythm on hospital arrival (shockable), and initial pH value (Ն7.0). MAIN OUTCOMES AND MEASURES The primary outcome was 1-month survival with favorable neurological outcome, defined by Cerebral Performance Category 1 or 2. In the development cohort, a simple scoring system was developed to predict this outcome using a logistic regression model. The diagnostic ability and calibration of the scoring system were assessed in the validation cohort. RESULTS A total of 916 patients were included, 458 in the development cohort (median [interquartile range {IQR}] age, 61 [47-69] years, 377 [82.3%] men) and 458 in the validation cohort (median [IQR] age, 60 [49-68] years; 393 [85.8%] men). The cohorts had the same proportion of favorable neurological outcome (57 patients [12.4%]). The prediction scoring system was developed, attributing a score of 1 for each clinical predictor. Patients were divided into 4 groups, corresponding to their scores on the prediction model, as follows: very low probability (score 0), low probability (score 1), middle probability (score 2), and high probability (score 3-4) of good neurological outcome. The mean predicted probabilities in the groups stratified by score were as follows: very low, 1.6% (95% CI, 1.6%-1.6%); low, 4.4% (95% CI, 4.2%-4.6%); middle, 12.5% (95% CI, 12.1%-12.8%); and high, 30.8% (95% CI, 29.1%-32.5%). In the validation cohort, the C statistic of the scoring system was (continued) Key Points Question Can the neurological outcome of patients with out-ofhospital cardiac arrest and shockable rhythm who are treated with extracorporeal cardiopulmonary resuscitation (ECPR) be predicted using accessible information? Findings In this prognostic study of 916 patients, a model using time to hospital arrival, pH in initial blood gas assessment, shockable rhythm on hospital arrival, and being younger than 65 years was developed to predict survival ...

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Section: Discussionmentioning

confidence: 99%

Development and Validation of a Clinical Score to Predict Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

et al. 2020

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“…Other than exposure history, fever, and other respiratory symptoms, pneumonia findings on chest imaging and abnormal laboratory findings are the main clues in the screening workflow of COVID-19 patients [ 12 ]. Several case reports of family clusters have previously been published, indicating the importance of early detection and isolation of the infected patients, as well as special caution needed for asymptomatic family members [ 6 , 13 , 14 ]. However, the features of these family clusters have not been systematically investigated, especially the similarities and dissimilarities between the first- and second-generations of COVID-19 within a family.…”

Section: Introductionmentioning

confidence: 99%

Features of family clusters of COVID-19 patients: A retrospective study

Diao

Zhang

Huang

et al. 2021

Travel Medicine and Infectious Disease

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Background To investigate and compare the clinical and imaging features among family members infected with COVID-19. Methods We retrospectively collected a total of 34 COVID-19 cases (15 male, 19 female, aged 48 ± 16 years, ranging from 10 to 81 years) from 13 families from January 17, 2020 through February 15, 2020. Patients were divided into two groups: Group 1 - part of the family members (first-generation) who had exposure history and others (second-generation) infected through them, and Group 2 - patients from the same family having identical exposure history. We collected clinical symptoms, laboratory findings, and high-resolution computed tomography (HRCT) features for each patient. Comparison tests were performed between the first- and second-generation patients in Group 1. Results In total there were 21 patients in Group 1 and 20 patients in Group 2. For Group 1, first-generation patients had significantly higher white blood cell count (6.5 × 10 9 /L (interquartile range (IQR): 4.9–9.2 × 10 9 /L) vs 4.5 × 10 9 /L (IQR: 3.7–5.3 × 10 9 /L); P = 0.0265), higher neutrophil count (4.9 × 10 9 /L (IQR: 3.6–7.3 × 10 9 /L) vs 2.9 × 10 9 /L (IQR: 2.1–3.3 × 10 9 /L); P = 0.0111), and higher severity scores on HRCT (3.9 ± 2.4 vs 2.0 ± 1.3, P = 0.0362) than the second-generation patients. Associated underlying diseases (odds ratio, 8.0, 95% confidence interval: 3.4–18.7, P = 0.0013) were significantly correlated with radiologic severity scores in second-generation patients. Conclusion Analysis of the family cluster cases suggests that COVID-19 had no age or sex predominance. Secondarily infected patients in a family tended to develop milder illness, but this was not true for those with existing comorbidities.

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“…In their comparison, the survival to hospital discharge of ECPR patients following OHCA ranged from 8 to 33%. In IHCA, it ranges between 19 and 60% [ 39 ]. Various other studies also showed improved neurological outcome and survival following ECPR compared with CCPR [ 14 , 15 , 30 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

ECPR—extracorporeal cardiopulmonary resuscitation

Kumar

2021

Indian J Thorac Cardiovasc Surg

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ECPR for out-of-hospital cardiac arrest: more evidence is needed

Cited by 38 publications

References 14 publications

Development and Validation of a Clinical Score to Predict Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Development and Validation of a Clinical Score to Predict Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Features of family clusters of COVID-19 patients: A retrospective study

ECPR—extracorporeal cardiopulmonary resuscitation

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