Extracorporeal Resuscitation of Cardiac Arrest

Abstract

Abstract. Objective: Extracorporeal support of heart and lung function (venoarterial perfusion) during cardiac arrest (ECPR) has been advocated as a means of improving survival following cardiac arrest. The authors retrospectively reviewed their institution's seven-year experience with this intervention. Methods: Emergency department patients and inpatients in cardiac arrest or immediately postarrest were considered candidates. ECPR was instituted using venoarterial bypass and was continued until patients regained sufficient cardiopulmonary function to allow weaning from the device or until their condition was deemed irrecoverable. Results: ECPR was attempted in 25 patients and successfully instituted in 21. Four patients (16%) were converted from ECPR to ventricular assist devices, two of whom survived and await transplantation. Seven additional patients were discharged from the hospital, resulting in an overall survival of 36%. Because none of the children treated survived, there was a trend toward higher age among survivors (survivors 40 Ϯ 14 yr, nonsurvivors 33 Ϯ 15 yr, p = 0.29). The duration of conventional CPR was shorter among survivors (survivors 21 Ϯ 16 min, nonsurvivors 43 Ϯ 32 min, p = 0.04), as was the duration of extracorporeal support (survivors 44 Ϯ 21 hr, nonsurvivors 87 Ϯ 96 hr, p = 0.18). Survival was seen only in patients whose conditions were amenable to a definitive therapeutic intervention, particularly cardiac arrest due to respiratory or pulmonary embolic disease. While four of the five patients treated in the ED were successfully supported, none survived to discharge. Conclusion: In select patients with reversible disease, extracorporeal CPR can be used to successfully treat cardiac arrest. Further investigation into its most appropriate application is warranted.

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

“…27 Similar observations of full neurologic recovery and survival to hospital discharge were reported after in situ extracorporeal perfusion for in-hospital cardiorespiratory arrest. 28 These observations confirm that the time required for irreversible loss of neurologic function after cessation of circulation is much longer than the 2-5 "Non-Heart-Beating" Organ Donation / Rady, Verheijde, and McGregorminutes of cardiorespiratory arrest required to begin the process of organ procurement in NHBOD.…”

Early Induction of Hypothermia During Cardiac Arrest Improves Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Who Undergo Emergency Cardiopulmonary Bypass and Percutaneous Coronary Intervention

“…12 Martin et al, 20 Younger et al 21 and our previous study 11 showed no benefit of emergency CPB with normothermia for neurological outcomes in patients who arrived at the ER in cardiac arrest, with the exception of cardiac arrest associated with accidental hypothermia or drug intoxication. On the other hand, Chen et al, 22 Hase et al, 23 and Kano et al 24 found that early implementation of emergency CPB with normothermia (<45 min 23 or <60 min 22,24 after cardiac arrest) was associated with better neurological outcomes.…”

“…Although several clinical studies of emergency CPB with normothermia for patients with cardiac arrest have been conducted, 11,[20][21][22][23][24][25] there have been few clinical studies of emergency CPB for induction of hypothermia. 12 Martin et al, 20 Younger et al 21 and our previous study 11 showed no benefit of emergency CPB with normothermia for neurological outcomes in patients who arrived at the ER in cardiac arrest, with the exception of cardiac arrest associated with accidental hypothermia or drug intoxication.…”

Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

“…Therefore, PCPS has been wildly used for severe cardiac failure, cardiogenic shock, and/or postoperative cardiac support. [3][4][5] Recently, a heparin-coated PCPS circuit including centrifugal pump and membrane oxygenator has been established, and PCPS can be started easily and quickly with this circuit. However, some PCPS patients cannot be easily weaned from its support.…”