Extracorporeal life support associated with hypothermia and normoxemia in refractory cardiac arrest

Fagnoul, David; Taccone, Fabio Silvio; Belhaj, Asmae; Rondelet, Benoît; Argacha, Jean-François; Vincent, Jean‐Louis; Backer, Daniel De

doi:10.1016/j.resuscitation.2013.06.016

Cited by 84 publications

(56 citation statements)

References 39 publications

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“…After contacting all authors, data on organ donation outcomes were provided from 5 additional studies 13,14,27,28,31 (Table 1). A total of 88 potential deceased donors among non-survivors from 8 out of the 20 included studies were identified.…”

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%

“…Most of the included studies presented high risk of confounding bias and threats to external validity because of their observational design. However, the methodological quality assessment of the 20 included studies resulted in a rating of good for 14 studies [12][13][14][15][16]18,20,[22][23][24][25][26][27][28] and fair for the other 6 17,19,21,29-31 (see Table 1). …”

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%

Section: Ecpr Studiesmentioning

confidence: 99%

See 1 more Smart Citation

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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“…[6][7][8][9][10][11] The option of organ donation remains if these attempts fail and irreversible cardiac arrest is declared, as when a bad neurologic prognosis follows despite of return of spontaneous circulation. [7][8][9][10] In fact, the patient's organs have received outstanding management in terms of preservation during resuscitation attempts, which minimizes warm ischemia time.…”

mentioning

confidence: 99%

“…Eligibility criteria [6][7][8][9][10] for patients in refractory cardiac arrest benefiting from early ECPR and PCI match with potential donors. [2][3][4][5] By implementing such a strategy, we avoid the identified conflicts of interest, 1-5 because we are really still treating a patient, rather than only preserving his or her organs.…”

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confidence: 99%

Protocols for Uncontrolled Donation After Circulatory Death: A Comprehensive Approach to Refractory Cardiac Arrest

Ortega-Deballon

Plaza-Horche

2014

Academic Emergency Medicine

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Extracorporeal cardiopulmonary resuscitation for in‐ and out‐of‐hospital cardiac arrest: systematic review and meta‐analysis of propensity score‐matched cohort studies

2020

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Introduction In this systematic review and meta‐analysis of propensity score‐matched cohort studies, we quantitatively summarize whether venoarterial extracorporeal membrane oxygenation (VA‐ECMO) used as extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), is associated with improved rates of 30‐day and long‐term favorable neurological outcomes and survival in patients resuscitated from in‐ and out‐of‐hospital cardiac arrest. Methods We searched MEDLINE via PubMed, Embase, Scopus, and Google Scholar for eligible studies on January 14, 2019. All searches were limited to studies published between January 2000 and January 2019. Two investigators independently evaluated the quality (or certainty) of evidence according to GRADE guidelines. Pooled results are presented as relative risks (RRs) with 95% confidence intervals (CIs). Results Six cohort studies using propensity score‐matched analysis were included, totaling 1108 matched patients. Pooled analyses showed that ECPR was likely associated with improved 30‐day and long‐term favorable neurological outcome in adults compared to CCPR for in‐ and out‐of‐hospital cardiac arrest (RR = 2.02, 95% CI = 1.29–3.16; I2 = 20%, P = 0.002; very low‐quality evidence) and (RR = 2.86, 95% CI = 1.64–5.01; I2 = 0%, P = 0.0002; moderate‐quality evidence), respectively. When we analyzed in‐ and out‐of‐hospital cardiac arrest separately, ECPR was likely associated with improved 30‐day favorable neurological outcome compared to CCPR for in‐hospital cardiac arrest (RR = 2.18, 95% CI = 1.24–3.81; I2 = 9%, P = 0.006; very low‐quality evidence), but not for out‐of‐hospital cardiac arrest (RR = 2.61, 95% CI = 0.56–12.20; I2 = 59%, P = 0.22; very low‐quality evidence). ECPR was also likely associated with improved long‐term favorable neurological outcome compared to CCPR for in‐hospital cardiac arrest (RR = 2.50, 95% CI = 1.33–4.71; I2 = 0%, P = 0.005; moderate‐quality evidence) and out‐of‐hospital cardiac arrest (RR = 4.64, 95% CI = 1.41–15.25; I2 = 0%, P = 0.01; moderate‐quality evidence). Conclusions Our analysis suggests that VA‐ECMO used as ECPR may improve long‐term favorable neurological outcomes and survival when compared to the best standard of care in a selected patient population. Therefore, it is imperative for well‐designed randomized clinical trials to obtain a higher level of scientific evidence to ensure optimal outcomes for cardiac arrest patients.

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Extracorporeal life support associated with hypothermia and normoxemia in refractory cardiac arrest

Cited by 84 publications

References 39 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

Protocols for Uncontrolled Donation After Circulatory Death: A Comprehensive Approach to Refractory Cardiac Arrest

Extracorporeal cardiopulmonary resuscitation for in‐ and out‐of‐hospital cardiac arrest: systematic review and meta‐analysis of propensity score‐matched cohort studies

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