Is Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest Superior Compared With Conventional Resuscitation?*

Dworschak, Martin

doi:10.1097/ccm.0b013e31828044c0

Cited by 8 publications

(6 citation statements)

References 14 publications

(14 reference statements)

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“…The currently poor neurological outcome after cardiac arrest with or without ECPR is often clinically initiated by convulsions and myoclonus. In this context, hypocapnia-induced vasoconstriction leading to tissue alkalosis and hypoxaemia might also play a certain role in the elicitation of seizures in susceptible patients immediately after global brain ischaemia [67–69].…”

Section: Resultsmentioning

confidence: 99%

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

et al. 2019

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BackgroundSystemic blood flow in patients on extracorporeal assist devices is frequently not or only minimally pulsatile. Loss of pulsatile brain perfusion, however, has been implicated in neurological complications. Furthermore, the adverse effects of absent pulsatility on the cerebral microcirculation are modulated similarly as CO2 vasoreactivity in resistance vessels. During support with an extracorporeal assist device swings in arterial carbon dioxide partial pressures (PaCO2) that determine cerebral oxygen delivery are not uncommon—especially when CO2 is eliminated by the respirator as well as via the gas exchanger of an extracorporeal membrane oxygenation machine. We, therefore, investigated whether non-pulsatile flow affects cerebrovascular CO2 reactivity (CVR) and regional brain oxygenation (rSO2).MethodsIn this prospective, single-centre case-control trial, we studied 32 patients undergoing elective cardiac surgery. Blood flow velocity in the middle cerebral artery (MCAv) as well as rSO2 was determined during step changes of PaCO2 between 30, 40, and 50 mmHg. Measurements were conducted on cardiopulmonary bypass during non-pulsatile and postoperatively under pulsatile blood flow at comparable test conditions. Corresponding changes of CVR and concomitant rSO2 alterations were determined for each flow mode. Each patient served as her own control.ResultsMCAv was generally lower during hypocapnia than during normocapnia and hypercapnia (p < 0.0001). However, the MCAv/PaCO2 slope during non-pulsatile flow was 14.4 cm/s/mmHg [CI 11.8–16.9] and 10.4 cm/s/mmHg [CI 7.9–13.0] after return of pulsatility (p = 0.03). During hypocapnia, non-pulsatile CVR (4.3 ± 1.7%/mmHg) was higher than pulsatile CVR (3.1 ± 1.3%/mmHg, p = 0.01). Independent of the flow mode, we observed a decline in rSO2 during hypocapnia and a corresponding rise during hypercapnia (p < 0.0001). However, the relationship between ΔrSO2 and ΔMCAv was less pronounced during non-pulsatile flow.ConclusionsNon-pulsatile perfusion is associated with enhanced cerebrovascular CVR resulting in greater relative decreases of cerebral blood flow during hypocapnia. Heterogenic microvascular perfusion may account for the attenuated ΔrSO2/ΔMCAv slope. Potential hazards related to this altered regulation of cerebral perfusion still need to be assessed.Trial registrationThe study was retrospectively registered on October 30, 2018, with Clinical Trial.gov (NCT03732651).

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Section: Resultsmentioning

confidence: 99%

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

et al. 2019

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“…Several studies demonstrated the ECPR is associated with significantly better results in in-hospital CPR than in out-of-hospital CA [6,[23][24][25][26][27][28][29][30][31][32]. This is probably due to the faster decision time and the more rapid initiation of ECPR, following the decision in IHCA patients.…”

Section: In-hospital Vs Out Of Hospital Ecprmentioning

confidence: 99%

“…The outcome for patients suffering an out of hospital cardiac arrest (OHCA) remains poor compared to patients with in-hospital cardiac arrest (IHCA), the latter having the advantage of rapid initiation of cardiopulmonary resuscitation (CPR) and early access to advanced support therapies [5,6].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

Benedek

Glogar

2016

The Journal of Critical Care Medicine

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This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.

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“…Not only might ECPR improve good quality survival, non-survivors may contribute to increased organ donation opportunities. 19,49 The possible staged and regulated expansion of VV(respiratory) ECMO and development of VA(cardiac)ECMO in additional centres, combined with the availability of cardiac bypass in many major hospitals and unregulated AV or VV-ECCO 2 R overall, will increase access to these technologies within the UK. As each of these extracorporeal technologies for respiratory and circulatory support could have a role when traditional options of management are failing for individual patients, intensivists should retain their interest and influence in these developments.…”

Section: Think -General Anaesthesia Local Anaesthesia Hypothermia and (Cardiopulmonary) Bypass -Professor J Whitwam (Circa 1985)mentioning

confidence: 99%

Problem Solving in Intensive Care — The Role of Extracorporeal Technologies

Noble

Bloomfield

2014

Journal of the Intensive Care Society

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Is Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest Superior Compared With Conventional Resuscitation?*

Cited by 8 publications

References 14 publications

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

Problem Solving in Intensive Care — The Role of Extracorporeal Technologies

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