Emergency Department Initiation of Cardiopulmonary Bypass: A Case Report and Review of the Literature

Shinar, Zachary; Bellezzo, Joe; Paradis, Norman A.; Dembitsky, Walter P.; Jaski, Brian E.; Mallon, William K.; Watt, Tim

doi:10.1016/j.jemermed.2011.06.134

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…While there was some variability in time points of reported outcomes, the overall reported survival rate was 22%, including 13% having a good neurological recovery (CPC 1-2 or GOS 4-5, see Table 1). In addition to these short-term results, three studies 12,13,19 reported patient outcomes at 3 months with an overall survival rate of 21% (24/115), including 15% (17/115) having good neurological function and five studies 16,20,22,26,30 reported patient outcomes at 6 months with an overall survival rate of 16% (61/377), including 9% (34/377) having good neurological function.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Four of the selected studies were conducted in Japan, 2 in Korea and 1 in Taiwan, [12][13][14][15][16][17][18] 5 in France, 19-23 2 in Germany 24,25 and 2 in Italy. 26,27 The remaining case series and reports were from Belgium, 28 Austria, 29 USA 30 and Australia. 31 The large majority of included studies were case reports, case series, and retrospective cohort studies, all of them LOE of 4.…”

Section: Ecpr Studiesmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…11 The use of ED ECMO remains poorly defined and fraught with anecdotal reports and local guidelines. It can be considered in any situation involving patients with potentially salvageable but otherwise likely fatal reversible respiratory and/or cardiac failure refractory to conventional management ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…20 Dramatic survival following the use of VA ECMO during or following cardiac arrest, as occurred in our patient, has been reported. 6,11,[21][22][23][24] A 2004 ''Best-Evidence Topic Report'' suggested that 15 to 25% of selected patients who suffer witnessed cardiac arrest and are unresponsive to traditional emergency cardiac care interventions may be successfully resuscitated with ECMO, 25 and two subsequently published studies have reported similar or higher survival rates. 26,27 Historically, the initiation of VA ECMO required advanced surgical training and an operating room environment.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Abu‐Laban

Migneault

Grant

et al. 2015

CJEM

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Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed. RÉ SUMÉL'oxygé nation extracorporelle sur oxygé nateur à membrane (OEOM) est un moyen de fournir une assistance cardiaque et respiratoire temporaire à des patients gravement malades. Le rô le de l'OEOM a gagné du terrain chez certains adultes aux services des urgences (SU) au cours des derniè res anné es. Sera exposé ici le cas spectaculaire d'un homme de 29 ans, soumis à l'OEOM veino-arté rielle pour un choc cardiogé nique et une insuffisance respiratoire suivant un collapsus et un arrê t cardiaque causé par un accè s prolongé de fibrillation ventriculaire, qui est survenu au SU de l'hô pital. Les moyens de ré animation mis en oeuvre avant le dé but de l'OEOM comprenaient des manoeuvres de ré animation cardiorespiratoire (RCR) pratiqué es de faç on quasi continue durant 49 minutes; 11 tentatives de dé fibrillation; l'administration de nombreux mé dicaments, dont un thrombolytique, pendant que se poursuivaient les manoeuvres de RCR; une intervention coronarienne percutané e et la pose d'une endoprothè se pour une dissection du segment moyen de l'artè re interventriculaire anté rieure et une oblité ration thrombotique; un soutien inotrope et la contrepulsion par ballon intra-aortique. Au cours des 48 heures suivant le dé but de l'OEOM, l'é tat cardiorespiratoire du patient s'est amé lioré rapidement, et celui-ci est retourné chez lui 9 jours aprè s son admission, et ce, sans souffrir de sé quelles neurologiques. Seront passé s en revue l'historique, les indications et le rô le de plus en plus grand de l'OEOM dans diverses affections, dont l'arrê t cardiaque.

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“…Extracorporeal CPR (E-CPR) describes the emergency application of portable cardiopulmonary bypass during closed-chest compressions to provide a bridge to recovery, decision, or definitive intervention. 1 Internationally, mounting observational data and propensity-matched analyses of E-CPR have demonstrated a distinct survival advantage relative to conventional CPR in adults with refractory cardiac arrest. [2][3][4][5] The lack of randomized data notwithstanding, E-CPR may represent one of the most important advances in acute resuscitation of the modern era.…”

mentioning

confidence: 99%

Functional outcomes after resuscitative extracorporeal membrane oxygenation for cardiac arrest: The patients speak for themselves

Bednarczyk

Singal

2015

The Journal of Thoracic and Cardiovascular Surgery

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Emergency Department Initiation of Cardiopulmonary Bypass: A Case Report and Review of the Literature

Cited by 15 publications

References 18 publications

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

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

Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion

Functional outcomes after resuscitative extracorporeal membrane oxygenation for cardiac arrest: The patients speak for themselves

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