Therapeutic Hypothermia May Improve Neurological Outcomes in Extracorporeal Life Support for Adult Cardiac Arrest
| Autor: | Anne E.E. Hoo, See Lim Lim, Yoong Kong Sin, Gillian H.L. Wee, Ismail Mohamed Tahir Sheriff, Philip Y.K. Pang, Jia Lin Soon, Ming Jie Huang, Zakir Hussain Abdul Salam, Ka Lee Kerk, Teing Ee Tan, Victor T.T. Chao, Chong Hee Lim, Yee Jim Loh |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Extracorporeal Circulation medicine.medical_specialty 030204 cardiovascular system & hematology Disease-Free Survival Extracorporeal 03 medical and health sciences Postoperative Complications 0302 clinical medicine Refractory Hypothermia Induced Humans Ischaemic hepatitis Medicine Hospital Mortality Retrospective Studies Adult patients business.industry 030208 emergency & critical care medicine Odds ratio Middle Aged Hypothermia Confidence interval Surgery Survival Rate Life support Anesthesia Heart Arrest Induced Female Nervous System Diseases medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart, Lung and Circulation. 26:817-824 |
| ISSN: | 1443-9506 |
| DOI: | 10.1016/j.hlc.2016.11.022 |
| Popis: | Background Limited data exists on patients receiving therapeutic hypothermia during extracorporeal life support (ECLS). We investigated outcomes and prognostic factors in these patients. Methods A retrospective review was conducted for 225 consecutive adult patients treated with ECLS between July 2003 and January 2016. Extracorporeal life support was initiated for refractory cardiac arrest (>10 mins) in 79 patients (35.1%). Patient demographics, ECLS-related complications, in-hospital mortality and neurological outcomes were analysed. Results The mean age was 49.9±12.4 years. Sixty-two patients (78.5%) were male. The mean duration of CPR and ECLS were respectively, 32.0±23.3 mins and 5.4±4.0 days. Therapeutic hypothermia (34 o C) was maintained for 24hours in 14 patients (17.7%). Thirty-five patients (44.3%) were weaned off ECLS. Twenty-one patients (26.6%) survived to hospital discharge with 16 (20.3%) recovering good neurological function. Compared to ECLS at normothermia, neurologically favourable survival was higher in the hypothermia group (42.9% vs 15.4%, p=0.020). Multivariable analysis identified a non-shockable rhythm [odds ratio (OR) 5.1, confidence interval (CI) 1.5–16.8], ischaemic hepatitis (OR 6.2, CI 1.1–33.6) and hypoxic ischaemic encephalopathy (OR 5.1, CI 1.5–17.1) as predictors of in-hospital mortality. Therapeutic hypothermia (OR 4.9, CI 1.2–20.4) and acute renal failure (OR 0.19, CI 0.05–0.70) were predictors of neurologically favourable survival. Conclusions In this report of patients treated with ECLS, in-hospital survival and survival with good neurological performance were 26.6% and 20.3% respectively. A non-shockable rhythm, ischaemic hepatitis and hypoxic ischaemic encephalopathy were predictors of in-hospital mortality. Therapeutic hypothermia during ECLS was associated with improved neurological outcomes. |
| Databáze: | OpenAIRE |
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