Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR)

Michels, Guido; Wengenmayer, Tobias; Hagl, Christian; Dohmen, Christian; Böttiger, Bernd W.; Bauersachs, Johann; Markewitz, Andreas; Bauer, Adrian; Gräsner, Jan–Thorsten; Pfister, Roman; Ghanem, Alexander; Busch, Hans-Jörg; Kreimeier, U.; Beckmann, Andreas; Fischer, Matthias; Kill, Clemens; Janssens, Uwe; Kluge, Stefan; Born, F.; Hoffmeister, Hans Martin; Preusch, Michael; Boeken, Udo; Riessen, Reimer; Thiele, Holger

doi:10.1007/s00063-018-0452-8

Cited by 22 publications

(5 citation statements)

References 76 publications

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“…To date, there are no well-validated cut-off values for serum lactate and pH that should be independently used for an ECPR decision. 29 It is far more crucial to consider the data overall; pathological laboratory findings can aid in the decisionmaking process, but they should not be used as a predictor.…”

Section: Discussionmentioning

confidence: 99%

The impact of on‐site cardiac rhythm on mortality in patients supported with extracorporeal cardiopulmonary resuscitation: A retrospective cohort study

et al. 2022

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Background Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used in patients with out‐of‐hospital or in‐hospital cardiac arrest in whom conventional cardiopulmonary resuscitation remains unsuccessful. The aim of this study was to analyze the impact of initial cardiac rhythm—detected on‐site of the cardiac arrest—on mortality. Methods We performed a retrospective cohort study of patients who received ECPR in our tertiary care cardiac arrest center. Patients were divided into three groups depending on their cardiac rhythm: shockable rhythm, pulseless electrical activity, and asystole. The primary endpoint was mortality within the first 7 days after ECPR deployment. Secondary endpoints were mortality within 28 days and the impact of pre‐ECPR potassium, serum lactate, pH, and pCO2 on mortality. The association of the initial cardiac rhythm and the location of arrhythmia detection (patient monitored in hospital [category: monitored], not monitored but hospitalized [in‐hospital], not monitored, not hospitalized [out‐of hospital]) with the primary and secondary outcome was examined by means of univariable and multivariable logistic regression. Results Sixty‐five patients could be included in the final analysis. Thirty‐two patients (49.2%, 95%CI 36.6%–61.9%) died within the first 7 days. In terms of 7‐day‐mortality patients differed in the initial cardiac rhythm (p = 0.040) and with respect to the location of arrhythmia detection (p = 0.002). Shockable cardiac rhythm (crude OR 0.21; 95%CI 0.03–0.98) and pulseless electrical activity (0.13; 0.02–0.61) as the initial rhythm on‐site showed better odds for survival compared to asystole. However, this association did neither persist in adjusted analysis nor pairwise comparison. Discussion The study could not demonstrate a better outcome with shockable rhythm after ECPR. More homogeneous and adequately powered cohorts are needed to better understand the impact of cardiac rhythm on patient outcomes after ECPR.

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Section: Discussionmentioning

confidence: 99%

The impact of on‐site cardiac rhythm on mortality in patients supported with extracorporeal cardiopulmonary resuscitation: A retrospective cohort study

et al. 2022

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“…Bei den pumpengetriebenen temporären extrakorporalen Unterstützungsverfahren unterscheidet man die extrakorporale Membranoxygenierung (ECMO), die eine ausschließlich pulmonale Unterstützung bietet, vom Extracorporeal Life Support (ECLS), einer kombinierten kardialen und pulmonalen Unterstützung. Es sei darauf hingewiesen, dass die venoarterielle extrakorporale Membranoxygenierung (va-ECMO) oftmals in der Literatur, im ECPR-Konsensuspapier [10] und in der jüngst publizierten S3-Leitlinie zum Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz-und Kreislaufversagen (https:// www.awmf.org/leitlinien/detail/ll/011-021.html) synonym als extrakorporales Life Support System (ECLS) definiert wird.…”

Section: Grundlagen Von Ecmo Und Eclsunclassified

“…Aufgrund der häufig zugrunde liegenden kardiologischen Genese des Herz-Kreislauf-Stillstandes sowie der für die Etablierung einer ECPR notwendigen apparativen und personellen Voraussetzungen scheinen zum gegenwärtigen Zeitpunkten ECPR-Programme nur in Kliniken sinnvoll, die über ein 24/7 verfügbares Herzkatheterlabor verfügen und eine intensivmedizinische Weiterversorgung dieser schwerkranken Patienten gewährleisten können. Weitere Empfehlungen zur Infrastruktur der Kliniken können dem Konsensuspapier von Michels et al [10] entnommen werden.…”

Section: Merke Ecpr Ist Ein Teamsport!unclassified

ECLS und eCPR – Was ist wichtig für den Notarzt?

Feth,

Hörsch,

Danziger

et al. 2023

Notfallmedizin up2date

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“…Im Rahmen der Versorgungsübernahme in der Notaufnahme sollten spätestens zu diesem Zeitpunkt der Akutbehand-▶ Tab. 6 Mögliche Entscheidungskriterien für oder gegen Einleitung einer eCPR [27,28].…”

Section: Merkeunclassified