Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience
| Autor: | David Gattas, Emily Granger, Mark Dennis, Sean Scott, Brian Burns, Paul Forrest, R. Pye, Peter McCanny, Mario D'Souza, Paul G. Bannon, David A Lowe, Richard Totaro |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Internal medicine Angioplasty Extracorporeal membrane oxygenation Humans Medicine Extracorporeal cardiopulmonary resuscitation Cardiopulmonary resuscitation Asystole Retrospective Studies business.industry Australia 030208 emergency & critical care medicine Retrospective cohort study Middle Aged medicine.disease Cardiopulmonary Resuscitation Heart Arrest Survival Rate Pulseless electrical activity Ventricular fibrillation Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | International Journal of Cardiology. 231:131-136 |
| ISSN: | 0167-5273 |
| Popis: | Aim To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications. Methods Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres in Sydney, Australia. Measurements and main results Thirty-seven patients underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age was 54 (IQR 47–58), 27 (73%) were male. Initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 20 patients (54%), pulseless electrical activity ( n =14, 38%), and asystole ( n =3, 8%). 27 (73%) arrests were witnessed and 30 (81%) patients received bystander CPR. Median time from arrest to initiation of ECMO flow was 45min (IQR 30–70), and the median time on ECMO was 3days (IQR 1–6). Angiography was performed in 54% of patients, and 27% required subsequent coronary intervention (stenting or balloon angioplasty 24%). A total of 13 patients (35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All survivors were discharged with favourable neurological outcome (Cerebral Performance Category 1 or 2). Pre-ECMO lactate level was predictive of mortality OR 1.35 (1.06–1.73, p =0.016). Conclusions In selected patients with refractory cardiac arrest, ECPR may provide temporary support as a bridge to intervention or recovery. We report favourable survival and neurological outcomes in one third of patients and pre-ECMO lactate levels predictive of mortality. Further studies are required to determine optimum selection criteria for ECPR. |
| Databáze: | OpenAIRE |
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