Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization

Richardson, Alexander Sacha C; Tonna, Joseph E.; Nanjayya, Vinodh Bhagyalakshmi; Nixon, Paul; Abrams, Darryl; Raman, Lakshmi; Bernard, Stephen; Finney, Simon J.; Grunau, Brian; Youngquist, Scott T.; McKellar, Stephen H.; Shinar, Zachary; Bartos, Jason A.; Becker, Lance B.; Yannopoulos, Demetris; Bˇelohlávek, Jan; Lamhaut, Lionel; Pellegrino, Vincent

doi:10.1097/mat.0000000000001344

Cited by 270 publications

(260 citation statements)

References 39 publications

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“…Although the difference in other survival markers of the patients is striking, the restoration of the cardiac rhythm during e-CPR is also found to be one of the important factors for better survival in the literature. [ 18 , 23 - 26 ]…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Gürcü¹,

Külahçıoğlu²,

Baysal³

et al. 2021

Turk Gogus Kalp Dama

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Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients. Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded. Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%. Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Gürcü¹,

Külahçıoğlu²,

Baysal³

et al. 2021

Turk Gogus Kalp Dama

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“…There is no consensus on the accepted indications for ECPR to date. The common inclusion criteria used in most ECPR studies on adult patients (32,33) (f) end-tidal CO 2 readings > 10 mmHg; and (g) 'signs of life' (spontaneous movements, breathing, gasping and pupillary reflexes) independent of the cardiac rhythm. However, these criteria have not been prospectively validated.…”

Section: Patient Selection and Indicationsmentioning

confidence: 99%

“…The recent Interim Guideline Consensus Statement from the ELSO recommended that 'locally agreed inclusion criteria' be formulated to help clinicians ensure appropriate allocation of resources to patients with the highest chances of survival after cardiac arrest. (32)…”

Section: Patient Selection and Indicationsmentioning

confidence: 99%

“…The recent Interim Guideline Consensus Statement from the ELSO recommends that the goal of ECPR is to establish adequate ECMO flow within 60 minutes of cardiac arrest. (32) This is a significant logistical challenge, as the time taken to deploy ECMO may differ between health systems and institutions owing to variations in infrastructure, staffing, training, pre-hospital transport times and EMS protocols (e.g. 'stay and treat' vs. 'scoop and run').…”

Section: Timing Of Ecprmentioning

confidence: 99%

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Extracorporeal life support in adult patients with out-of-hospital cardiac arrest

Lim¹,

Chakaramakkil²,

Tan³

2021

smedj

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The use of extracorporeal life support in cardiopulmonary resuscitation (CPR) of adult patients experiencing out-of-hospital cardiac arrest by the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest has been increasing over the past decade. This can be attributed to the encouraging results of extracorporeal CPR (ECPR) in multiple observational studies. To date, only one randomised controlled trial has compared ECPR to conventional advanced life support measures. Patient selection is crucial for the success of ECPR programmes. A rapid and organised approach is required for resuscitation, i.e. cannula insertion with ECMO pump initiation in combination with other aspects of post-cardiac arrest care such as targeted temperature management and early coronary reperfusion. The provision of an ECPR service can be costly, resource intensive and technically challenging, as limited studies have reported on its cost-effectiveness.

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“…[22] Over the last few years, the use of extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) has been growing, and may provide a signi cant survival bene t over conventional CPR (CCPR) in patients with refractory CA. [23,24] However while ECPR provides both mechanical haemodynamic and oxygenation support, [25][26][27] ECPR may also be associated with signi cantly elevated arterial oxygen levels. [1,12,13] To date, little is known about the incidence of hyperoxia in patients treated with ECPR compared to CCPR, and whether there is an association between hyperoxia and poor outcomes, independent of the method of resuscitation.…”

Section: Introductionmentioning

confidence: 99%

Hyperoxia and mortality in Conventional versus Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation

Stoll

Paul

Pilcher

et al. 2021

Preprint

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BackgroundHyperoxia has been associated with adverse outcomes in post cardiac arrest (CA) patients. However, little data are available from mixed cohorts, where extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) and conventional CPR (CCPR) were utilised. The independence of effect of hyperoxia in this setting is not clear. Study-objective was to examine the association between hyperoxia and 30-day mortality in a mixed cohort of ECPR and CCPR patients.Methods and designThis was a retrospective cohort study of CA patients admitted to a tertiary level cardiac arrest centre in Australia from 1st January 2013 to 31st August 2018. Mean arterial oxygen levels (PaO2) and episodes of extreme hyperoxia (PaO2 ≥ 300mmHg) were analysed over the first 8 days. The primary outcome was 30-day mortality.ResultsA total of 169 post CA patients were assessed over a 6.5-year time period: 79 patients undergoing ECPR vs 90 patients undergoing CCPR. The mean age of the cohort was 54 (± 17) years; 126/169 (74%) were male and 119/169 (70%) were treated for out of hospital cardiac arrest (OHCA). Compared to CCPR, ECPR patients were younger, had a longer low flow time and higher illness severity scores on admission. Mean PaO2-levels were higher in patients in the ECPR vs CCPR group (211mmHg ± 58.4 vs 119mmHg ± 18.1; p < 0.0001) as was the proportion with at least one episode of extreme hyperoxia (58/79 (73%) vs 36/90 (40%), p < 0.01). ECPR patients presented with a higher mortality (54.4%) vs CCPR patients (34.4%). After adjusting for age, sex, BMI, highest lactate pre-treatment, use of ECMO, low flow time, pulse pressure on admission day, and severity of illness (APACHE III score), any episode of extreme hyperoxia was independently associated with a 2.57-fold increased risk of 30-day mortality (OR: 2.57, 95% CI: 1.09–6.06; p = 0.031) irrespective of the CPR-mode.ConclusionWe found extreme hyperoxia (PaO2-level ≥ 300mmHg) was more common in ECPR patients in the first 8 days post CA and was independently associated with higher 30-day mortality, irrespective of whether ECPR was employed. Prospective studies that compare different oxygen targets are needed to see if a strategy of lower oxygen exposure improves outcomes.

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Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization

Cited by 270 publications

References 39 publications

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Extracorporeal life support in adult patients with out-of-hospital cardiac arrest

Hyperoxia and mortality in Conventional versus Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation

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