Emergency extracorporeal membrane oxygenation in a hospital without on-site cardiac surgical facilities

Belle, Loïc; Mangin, Lionel; Bonnet, H; Fol, S; Santré, Charles; Delavenat, L.; Savary, Dominique; Bougon, David; Vialle, Emmanuelle; Dompnier, Antoine; Desjoyaux, Emmanuel; Blin, Dominique

doi:10.4244/eijv8i3a57

Cited by 36 publications

(33 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note, however, patients with renal failure, as well as those that were centrally cannulated, two populations well-represented in our study, were excluded from analysis. Belle et al 12 described a similar cohort of 51 patients and reported only a 27.5% survival to discharge, likely due to the high percentage of patients cannulated in the setting of refractory cardiac arrest (47.1%). Flécher et al 13 recently published one of the largest series reporting outcomes of VA-ECMO for RCS with 260 patients.…”

Section: Discussionmentioning

confidence: 90%

Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

et al. 2015

View full text Add to dashboard Cite

Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age (p = 0.002) and etiology of RCS (p = 0.041) as the most significant predictors of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.

show abstract

Section: Discussionmentioning

confidence: 90%

Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

et al. 2015

View full text Add to dashboard Cite

show abstract

“…While robust reporting of similar complication rates exists for ECPR used for IHCA or IHCA and OHCA combined [7,14,16,23–25], less is available for comparison for strictly OHCA [6,8,9,11,12,15]. This robust reporting of international complication rates associated with ECPR following OHCA can provide centers wishing to monitor institutional complication rates a benchmark for comparison, and can guide decision making around risk-benefit decisions associated with this relatively complex and resource-intensive therapy.…”

Section: Discussionmentioning

confidence: 99%

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

et al. 2017

View full text Add to dashboard Cite

Aim Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy for refractory cardiac arrest. The purpose of this study was to analyze and report characteristics and outcomes of adult patients treated with ECPR after out-of-hospital cardiac arrest (OHCA) in a large international registry. Methods The Extracorporeal Life Support Organization’s Extracorporeal Life Support Registry was queried for adult cardiac arrests with arrest location of “EMT Transport” or “Outside Hospital.” Results From 2010–2016, 217 cases of ECPR following OHCA were reported in Europe (47%), Asia-Pacific (29%), and North America (24%). The median age was 52 years (IQR 45–62, range 18–87); 73% were male. The median duration of ECPR was 47 h (IQR 17–94, range 0–711). Reported complications included hemorrhage (31.3%), limb complications (11.1%), circuit complications (8.8%), infection (7.4%), and seizures (5.5%). The rate of percutaneous coronary intervention (PCI) was higher in Europe (35.6%) and Asia-Pacific (25.8%) than North America (9.4%; p < 0.01). Survival to hospital discharge was 27.6% (95% CI 22.1–34.0%), and male gender was independently associated with mortality (adjusted odds ratio 2.1 [95% CI 1.1–4.2], p < 0.05). Survival did not differ by region, race, age, or year. Brain death was reported in 16.6% [95% CI 12.2–22.1%]; organ donation rate was not reported. Conclusion This international analysis of ECPR for refractory OHCA reveals a survival rate of 27.6%, demonstrates association of male gender with mortality, and highlights regional differences in PCI utilization. These results will help inform implementation and research of this potentially life-saving strategy for refractory OHCA.

show abstract

“…The difference in outcome between IHCA and OHCA results more from the duration of cardiac arrest than from the location of cardiac arrest itself (Tables 1-3) [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. The difference in outcome between IHCA and OHCA results more from the duration of cardiac arrest than from the location of cardiac arrest itself (Tables 1-3) [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57].…”

Section: Extracorporeal Membrane Oxygenation For Out-of-hospital Cardmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Fagnoul

Combes

Backer

2014

Current Opinion in Critical Care

130

View full text Add to dashboard Cite

This review highlights that ECPR is feasible for both IHCA and OHCA. In the recent series, the outcome of ECPR in IHCA is satisfactory, with survival rates good with neurologic outcome reaching the 40-50% range. All series converge in highlighting that time from cardiac arrest to ECMO flow is a critical determinant of outcome, with survival rates of 50% when initiated within 30 min of IHCA, 30% between 30 and 60 min, and 18% after 60 min. Results of ECPR in OHCA are more challenging. Recent series suggest that good outcome can be obtained in 15-20% of the patients, provided that time from arrest to ECMO is shorter than 60 min. Duration of cardiac arrest seems to be more important than location of cardiac arrest. ECPR thus seems to be a valuable option in selected cases.

show abstract

Emergency extracorporeal membrane oxygenation in a hospital without on-site cardiac surgical facilities

Cited by 36 publications

References 24 publications

Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

Extracorporeal cardiopulmonary resuscitation

Contact Info

Product

Resources

About