Bourcier, Simon and Desnos, Cyrielle and Clement, Marina and Hekimian, Guillaume and Brechot, Nicolas and Taccone, Fabio Silvio and Belliato, Mirko and Pappalardo, Federico and Broman, Lars Mikael and Malfertheiner, Maximilian Valentin and Lunz, Dirk and Schmidt, Matthieu and Leprince, Pascal and Combes, Alain and Lebreton, Guillaume and Luyt, Charles-Edouard (2022) Extracorporeal cardiopulmonary resuscitation for refractory in-hospital cardiac arrest: A retrospective cohort study. INTERNATIONAL JOURNAL OF CARDIOLOGY, 350. pp. 48-54. ISSN 0167-5273, 1874-1754
Full text not available from this repository. (Request a copy)Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue therapy for refractory cardiac arrest, but its high mortality has raised questions about patient selection. No selection criteria have been proposed for patients experiencing in-hospital cardiac arrest. We aimed to identify selection criteria available at the time ECPR was considered for patients with in-hospital cardiac arrest. We analyzed data of in-hospital cardiac arrest patients undergoing ECPR in our extracorporeal membrane oxygenation (ECMO) center (March 2007 to March 2019). Intensive care unit (ICU) and 1-year survival post-hospital discharge were assessed. Factors associated with ICU survival before ECPR were investigated. An external validation cohort from a previous multicenter study was used to validate our results. Results: Among the 137 patients (67.9% men; median [IQR] age, 54 [43-62] years; low-flow duration, 45 [30-70] min) requiring ECPR, 32.1% were weaned-off ECMO. Their respective ICU- and 1-year survival rates were 21.9% and 19%. Most 1-year survivors had favorable neurological outcomes (cerebral performance category score 1 or 2). ICU survivors compared to nonsurvivors, respectively, were more likely to have a shockable initial rhythm (53.3% versus 24.3%; P < 0.01), a shorter median (IQR) low-flow time (30 (25-53) versus 50 (35-80) min, P < 0.01) and they more frequently underwent a subsequent intervention (63.3% versus 26.2%, P < 0.01). The algorithm obtained by combining age, initial rhythm and low-flow duration discriminated between patient groups with very different survival probabilities in the derivation and validation cohorts. Conclusion: Survival of ECPR-managed in-hospital cardiac arrest patients in this cohort was poor but hospital survivors' 1-year neurological outcomes were favorable. When deciding whether or not to use ECPR, the combination of age, initial rhythm and low-flow duration can improve patient selection.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MEMBRANE-OXYGENATION; LIFE-SUPPORT; COUNCIL GUIDELINES; OF-LIFE; SURVIVAL; OUTCOMES; AGE; Cardiac arrest; ECPR; In-hospital; Prognosis; Survival |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 26 Jan 2024 14:06 |
| Last Modified: | 29 Jan 2024 13:59 |
| URI: | https://pred.uni-regensburg.de/id/eprint/58050 |
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