Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: An Italian tertiary care centre experience

Avalli, Leonello; Maggioni, Elena; Formica, Francesco; Redaelli, G; Migliari, Maurizio; Scanziani, Margherita; Celotti, Simona; Coppo, Anna; Caruso, Rosa; Ristagno, Giuseppe; Fumagalli, Roberto

doi:10.1016/j.resuscitation.2011.10.013

Cited by 152 publications

(120 citation statements)

References 32 publications

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“…While there was some variability in time points of reported outcomes, the overall reported survival rate was 22%, including 13% having a good neurological recovery (CPC 1-2 or GOS 4-5, see Table 1). In addition to these short-term results, three studies 12,13,19 reported patient outcomes at 3 months with an overall survival rate of 21% (24/115), including 15% (17/115) having good neurological function and five studies 16,20,22,26,30 reported patient outcomes at 6 months with an overall survival rate of 16% (61/377), including 9% (34/377) having good neurological function.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies 19,23,26 reported on potential organ donors from the group of non-survivors with anoxic brain injury, including donation after brain death (DBD) and controlled donation after circulatory determination of death (cDCD). After contacting all authors, data on organ donation outcomes were provided from 5 additional studies 13,14,27,28,31 (Table 1).…”

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%

“…The main exclusion criteria were the pre-existence of severe comorbidities, neurological disabilities, a valid do not attempt resuscitation order and the identification of a primary non-cardiac etiology (Table 2). • Catheter Lab + IABP: 1 study 17 • Catheter Lab + IABP + TTM: 9 studies [13][14][15][16][18][19][20]26,27 CPR, cardiopulmonary resuscitation; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; TTM, targeted temperature management, also known as therapeutic mild hypothermia; IABP, intra-aortic balloon pump.…”

Section: Patient Characteristicsmentioning

confidence: 99%

See 4 more Smart Citations

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: Discussionmentioning

confidence: 99%

Section: Ecpr Studiesmentioning

confidence: 99%

Section: Ecpr Studiesmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

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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Systematic review to assess the possibility of return of cerebral and cardiac activity after normothermic regional perfusion for donors after circulatory death

Shapey

Summers

Augustine

et al. 2019

British Journal of Surgery

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Background Normothermic regional perfusion (NRP) is a novel technique that aids organ recovery from donors after circulatory death (DCDs). However, ethical concerns exist regarding the potential return of spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to determine the likelihood of ROSCCA in NRP‐DCDs of abdominal organs. Methods Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out‐of‐hospital cardiac arrest (OOHCA) was identified as a comparator for NRP‐DCDs and as a validation cohort. A systematic search identified all articles relating to NRP‐DCDs and ECPR‐OOHCA. Rates of ROSCCA and survival outcomes (ECPR‐OOHCA only) were recorded and analysed according to the duration of no perfusion. Results In NRP‐DCDs, 12 of 410 articles identified by database searching were eligible for inclusion. There were no instances of ROSCCA recorded among 493 donors. In ECPR‐OOHCA, eight of 947 screened articles were eligible for inclusion (254 patients). Where the absence of perfusion exceeded 5 min in ECPR‐OOHCA, there were no survivors with a favourable neurological outcome. Conclusion ROSCCA is unlikely following commencement of NRP and has not occurred to date. Strict observance of the 5‐min interval following asystole provides satisfactory assurance that ROSCCA will not occur following NRP.

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Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

Sorokin

MacLaren

Vidanapathirana

et al. 2017

European J of Heart Fail

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Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of which must be comprehensively monitored. Changes in the patient's status or suboptimal ECMO-related support, however, may occur and should trigger re-appraisal of the cannulation strategy and circuit configuration. This dynamic management, based around the adequacy of end organ perfusion and patient requirements, may dictate ECMO configuration and cannulation changes. In these circumstances, adjunct of a cannula in the venous or arterial vasculature may represent a mandatory procedure to solve unfavorable hemodynamic status or enhance ECMO efficiency. These type of ECMO configurations, different from basic one, and called hybrid configurations, may represent, therefore, a critical aspect of optimal ECMO management towards optimized and successful temporary support. The aim of this review is to critically appraise and summarize the existing literature on adult ECMO configuration including cannulation strategies and circuit arrangement, and highlighting more complex pattern required in some specific clinical settings.

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Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: An Italian tertiary care centre experience

Cited by 152 publications

References 32 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

Systematic review to assess the possibility of return of cerebral and cardiac activity after normothermic regional perfusion for donors after circulatory death

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

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