Survival After Extracorporeal Cardiopulmonary Resuscitation on Weekends in Comparison With Weekdays

Lee, Dae-Sang; Chung, Chi Ryang; Jeon, Kyeongman; Park, Chi-Min; Suh, Gee Young; Song, Young Bin; Hahn, Joo‐Yong; Choi, Seung–Hyuk; Choi, Jin‐Ho; Gwon, Hyeon‐Cheol; Yang, Jeong Hoon

doi:10.1016/j.athoracsur.2015.06.077

Cited by 39 publications

(35 citation statements)

References 16 publications

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“…In our meta-analysis, this association between time to ECMO and survival is not found. However, most of the studies included in our meta-analysis do nd a relationship between time to ECMO and survival, when this was investigated [18,[22][23][24][25][26][27]34]. Possibly, our results can be explained due to an aggregation effect: our results imply that -because the variation in outcome between studies was small-differences in mean calculated time to ECMO do not explain differences in mean survival between studies.…”

Section: Discussionmentioning

confidence: 60%

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Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Gravesteijn

Schluep

Disli

et al. 2020

Preprint

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Background: In hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. Methods: We performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. Results: Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI: 28-33%, I2=0%, p=0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI: 80-88%, I2=24%, p=0.90). Conclusion: CPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.

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Section: Discussionmentioning

confidence: 60%

“…None replied after multiple attempts, therefore these studies were excluded. Finally, 19 articles were included [17,18,[27][28][29][30][31][32][33][34][35][19][20][21][22][23][24][25][26] (Fig 1).…”

Section: Included Articlesmentioning

confidence: 99%

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Gravesteijn

Schluep

Disli

et al. 2020

Preprint

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“…Only few studies exist on the outcomes of patients with cardiac arrest with extracorporeal cardiopulmonary resuscitation on the weekday versus the weekend; however, study in adults suggests extracorporeal cardiopulmonary resuscitation on the weekend was associated with a lower survival and higher complications. 26 The most common indication for extracorporeal membrane oxygenation support in this cohort was cardiac arrest, and immediate availability of necessary personnel for rescue cannulation may be highest during the workweek. Thus weekend/night availability may play a role in the association with mortality.…”

Section: Indicationmentioning

confidence: 89%

Risk factors for mortality in paediatric cardiac ICU patients managed with extracorporeal membrane oxygenation

et al. 2018

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BackgroundVeno-arterial extracorporeal membrane oxygenation is frequently used in patients with cardiac disease. We evaluated short-term outcomes and identified factors associated with hospital mortality in cardiac patients supported with veno-arterial extracorporeal membrane oxygenation.MethodsA retrospective review of patients supported with veno-arterial extracorporeal membrane oxygenation at a university-affiliated children’s hospital was performed.ResultsA total of 253 patients with cardiac disease managed with extracorporeal membrane oxygenation were identified; survival to discharge was 48%, which significantly improved from 39% in an earlier era (1995–2001) (p=0.01). Patients were categorised into surgical versus non-surgical groups on the basis of whether they had undergone cardiac surgery before or not, respectively. The most common indication for extracorporeal membrane oxygenation was extracorporeal cardiopulmonary resuscitation: 96 (51%) in the surgical group and 45 (68%) in the non-surgical group. In a multiple covariate analysis, single-ventricle physiology (p=0.01), duration of extracorporeal membrane oxygenation (p<0.01), and length of hospital stay (p=0.03) were associated with hospital mortality. Weekend or night shift cannulation was associated with mortality in non-surgical patients (p=0.05).ConclusionWe report improvement in survival compared with an earlier era in cardiac patients supported with extracorporeal membrane oxygenation. Single-ventricle physiology continues to negatively impact survival, along with evidence of organ dysfunction during extracorporeal membrane oxygenation, duration of extracorporeal membrane oxygenation, and length of stay.

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“…No access to interventional radiology or operating theatres. Failure to cannulate Hospital-based percutaneous VA-ECMO cannulation has a reported failure rate between 7% and 10% [ 52 , 53 ] and is anticipated to be higher in the pre-hospital environment. Surgical cut down may reduce the expected failure rate in the pre-hospital setting.…”

Section: Complicationsmentioning

confidence: 99%

“…Surgical cut down may reduce the expected failure rate in the pre-hospital setting. Limb Ischaemia In-hospital limb ischaemia after insertion of VA-ECMO cannulae is reported in the range of 12–15% [ 31 , 52 ] and would be similar in the pre-hospital environment. The usual practice of inserting a retrograde distal limb perfusion cannula would be deferred until arrival at hospital.…”

Section: Complicationsmentioning

confidence: 99%

Pre-hospital extra-corporeal cardiopulmonary resuscitation

Singer

Reynolds

Lockey

et al. 2018

Scand J Trauma Resusc Emerg Med

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Survival from out-of-hospital cardiac arrest (OHCA) has remained low despite advances in resuscitation science. Hospital-based extra-corporeal cardiopulmonary resuscitation (ECPR) is a novel use of an established technology that provides greater blood flow and oxygen delivery during cardiac arrest than closed chest compressions. Hospital-based ECPR is currently offered to selected OHCA patients in specialized centres. The interval between collapse and restoration of circulation is inversely associated with good clinical outcomes after ECPR. Pre-hospital delivery of ECPR concurrent with conventional resuscitation is one approach to shortening this interval and improving outcomes after OHCA. This article examines the background and rationale for pre-hospital ECPR; summarises the findings of a literature search for published evidence; and considers candidate selection, logistics, and complications for this complex intervention.

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Survival After Extracorporeal Cardiopulmonary Resuscitation on Weekends in Comparison With Weekdays

Abstract: ECPR on the weekend was associated with a lower survival rate and lower resuscitation quality, including higher cannulation failure and higher complication rate.

Cited by 39 publications

References 16 publications

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Risk factors for mortality in paediatric cardiac ICU patients managed with extracorporeal membrane oxygenation

Pre-hospital extra-corporeal cardiopulmonary resuscitation

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