Venoarterial Extracorporeal Membrane Oxygenation in Adults With Cardiac Arrest

Patel, Jignesh; Schoenfeld, Elinor; Parnia, Sam; Singer, Adam J.; Edelman, Norman H.

doi:10.1177/0885066615583651

Cited by 9 publications

(5 citation statements)

References 80 publications

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“…Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective adjunct treatment for CA. In the recent years, the use of ECMO in resuscitative medicine is increasing, and general ECMO practice has been summarized in several trials and reviews [6, 7]. Considering that application of extracorporeal CPR (EPCR) maintains organ perfusion and provides time to reverse the cause of CA, apply a left ventricular assist device or heart transplant, or both.…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy of Extracorporeal Cardiopulmonary Resuscitation for Adults with Cardiac Arrest: Meta-Analysis with Trial Sequential Analysis

Chen

Liu

Huang

et al. 2019

BioMed Research International

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Objective. This meta-analysis with trial sequential analysis (TSA) compared the clinical efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) with conventional CPR (CCPR) for adult patients who experienced in-hospital cardiac arrest (IHCA) or out-of-hospital CA (OHCA). Methods. A literature search was used to identify eligible publications (up to 30 July 2018) from PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase. Two investigators independently conducted the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and TSA were used to analyze each outcome, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence. The primary outcome was 30-day survival, and the secondary outcomes were 30-day neurologic outcome, 3-6 months’ survival, 3-6 months’ neurological outcome, 1-year survival, and 1-year neurological outcome. Results. We identified 13 eligible observational studies for the final analysis. Pooled analyses showed that ECPR was associated with a significantly better 30-day survival (RR = 1.60, 95% CI = 1.25–2.06) and 30-day neurologic outcome (RR = 2.69, 95% CI = 1.63–4.46), and TSA confirmed these results. However, subgroup analysis of patients with OHCA indicated that ECPR and CCPR had similar effects on 30-day survival (RR = 1.18, 95% CI = 0.71–1.97), which was not confirmed by TSA. Analysis of OHCA patients indicated that ECPR provided a better 30-day neurological outcome (RR = 3.93, 95% CI = 1.00–15.50), but TSA did not support these results. Analysis of IHCA patients indicated that ECPR was associated with a better 30-day survival (RR 1.90, 95% CI 1.43–2.52) and 30-day neurologic outcome (RR 2.02, 95% CI 1.21–3.39), and TSA supported these results. Other subgroup analyses showed that the results were generally consistent, regardless of nation, propensity score matching, presumed etiology, whether the CA was witnessed or not, and study quality. Conclusions. Relative to CCPR, ECPR improved the survival and neurological outcome of patients who had IHCA. Compared to IHCA patients, TSA could not confirm better survival and neurologic outcome of ECPR in OHCA patients, suggesting that further studies are needed. Trial Registration. This trial was registered with PROSPERO (CRD42018100513) on 17 July 2018.

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Section: Introductionmentioning

confidence: 99%

Clinical Efficacy of Extracorporeal Cardiopulmonary Resuscitation for Adults with Cardiac Arrest: Meta-Analysis with Trial Sequential Analysis

Chen

Liu

Huang

et al. 2019

BioMed Research International

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“…ECPR is indicated in suspected cardiac arrest if the following criteria are met: 1) age <75 years, 2) no-flow time <5 minutes, and 3) ROSC for less than 30 minutes without uncontrollable bleeding, previous severe neurologic deficit, previous end-stage organ failure, or current intracranial hemorrhage. These criteria are in alignment with current recommendations 12) 13) 14) but are not an absolute indication.…”

Section: Methodsmentioning

confidence: 60%

Extracorporeal Cardiopulmonary Resuscitation with Therapeutic Hypothermia for Prolonged Refractory In-hospital Cardiac Arrest

et al. 2017

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Background and ObjectivesWe identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) followed by therapeutic hypothermia on survival and neurologic outcome in patients with prolonged refractory in-hospital cardiac arrest (IHCA).MethodsWe enrolled 16 adult patients who underwent ECPR followed by therapeutic hypothermia between July 2011 and December 2015, for IHCA. Survival at discharge and cerebral performance category (CPC) scale were evaluated.ResultsAll patients received bystander cardiopulmonary resuscitation (CPR); the mean CPR time was 66.5±29.9 minutes, and the minimum value was 39 minutes. Eight patients (50%) were discharged alive with favorable neurologic outcomes (CPC 1–2). The mean follow-up duration was 20.1±24.3 months, and most deaths occurred within 21 days after ECPR; thereafter, no deaths occurred within one year after the procedure.ConclusionECPR followed by therapeutic hypothermia could be considered in prolonged refractory IHCA if bystander-initiated conventional CPR is performed.

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“…Unfortunately, the number of cardiac arrest patients in the United States that meet such inclusion criteria is few (<10% of all arrests). 44,45 While there are clear potential benefits for some patients with ECPR, there is another side to that coin. Complication rates of ECPR are not trivial.…”

Section: Rationale For Ecprmentioning

confidence: 99%

“…Taken together, the literature on ECPR for OHCA suggests some survival advantage with optimal patient selection and early cannulation. Unfortunately, the number of cardiac arrest patients in the United States that meet such inclusion criteria is few (<10% of all arrests) 44,45 …”

Section: Rationale For Ecprmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation for refractory out‐of‐hospital cardiac arrest: Lessons learned from recent clinical trials

DeMasi,

Donohue,

Merck

et al. 2024

JACEP Open

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Cardiac arrest is a leading contributor to morbidity and mortality in the United States. Survival has been historically dependent on high‐quality cardiopulmonary resuscitation (CPR) and rapid defibrillation. However, a large percentage of patients remain in refractory cardiac arrest despite adherence to structured advanced cardiac life support algorithms in which these factors are emphasized. Veno‐arterial extracorporeal membrane oxygenation is becoming an increasingly used rescue therapy for patients in refractory cardiac arrest to restore oxygen delivery by extracorporeal CPR (ECPR). Recently published clinical trials have provided new insights into ECPR for patients who sustain an outside hospital cardiac arrest (OHCA). In this narrative review, we summarize the rationale for, results of, and remaining questions from these recently published clinical trials. The existing observational data combined with the latest clinical trials suggest ECPR improves mortality in patients in refractory arrest. However, a mixed methods trial is essential to understand the complexity, context, and effectiveness of implementing an ECPR program.

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Venoarterial Extracorporeal Membrane Oxygenation in Adults With Cardiac Arrest

Cited by 9 publications

References 80 publications

Clinical Efficacy of Extracorporeal Cardiopulmonary Resuscitation for Adults with Cardiac Arrest: Meta-Analysis with Trial Sequential Analysis

Clinical Efficacy of Extracorporeal Cardiopulmonary Resuscitation for Adults with Cardiac Arrest: Meta-Analysis with Trial Sequential Analysis

Extracorporeal Cardiopulmonary Resuscitation with Therapeutic Hypothermia for Prolonged Refractory In-hospital Cardiac Arrest

Extracorporeal cardiopulmonary resuscitation for refractory out‐of‐hospital cardiac arrest: Lessons learned from recent clinical trials

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