Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Out-of-Hospital Cardiac Arrest due to Pulseless Ventricular Tachycardia/Fibrillation.

Autor: Boudoulas KD; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Whitson BA; Division of Cardiothoracic Surgery, The Ohio State University, Columbus, Ohio, USA., Keseg DP; Columbus Division of Fire, Columbus, Ohio, USA., Lilly S; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Baker C; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Attar T; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Capers Q 4th; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Gumina RJ; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Mast DW; Perfusion Services, The Ohio State University, Columbus, Ohio, USA., Satyapriya SV; Department of Anesthesiology, The Ohio State University, Columbus, Ohio, USA., Davenport D; Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Hazlett M; Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Mokadam N; Division of Cardiothoracic Surgery, The Ohio State University, Columbus, Ohio, USA., Magorien R; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Mazzaferri EL Jr; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA.
Jazyk: angličtina
Zdroj: Journal of interventional cardiology [J Interv Cardiol] 2020 Jul 17; Vol. 2020, pp. 6939315. Date of Electronic Publication: 2020 Jul 17 (Print Publication: 2020).
DOI: 10.1155/2020/6939315
Abstrakt: Background: Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire.
Methods: From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL).
Results: From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant ( p =0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO 2 , pH, and hemoglobin. Recovery was seen in different underlying pathologies.
Conclusion: ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.
Competing Interests: The authors declare that they have no conflicts of interest.
(Copyright © 2020 Konstantinos Dean Boudoulas et al.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje