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Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study

Intensive Care Medicine volume 46, pages 973–982 (2020)Cite this article

Abstract

Purpose

The aim of this study was to assess the neurologic outcome following extracorporeal cardiopulmonary resuscitation (ECPR) in five European centers.

Methods

Retrospective database analysis of prospective observational cohorts of patients undergoing ECPR (January 2012–December 2016) was performed. The primary outcome was 3-month favorable neurologic outcome (FO), defined as the cerebral performance categories of 1–2. Survival to ICU discharge and the number of patients undergoing organ donation were secondary outcomes. A subgroup of patients with stringent selection criteria (i.e., age ≤ 65 years, witnessed bystander CPR, no major co-morbidity and ECMO implemented within 1 h from arrest) was also analyzed.

Results

A total of 423 patients treated with ECPR were included (median age 57 [48–65] years; male gender 78%); ECPR was initiated for OHCA in 258 (61%) patients. Time from arrest to ECMO implementation was 65 [48–84] min. Eighty patients (19%) had favorable neurological outcome. ICU survival was 24% (n = 102); 23 (5%) non-survivors underwent organ donation procedures. Favorable neurological outcome rate was lower (9% vs. 34%, p < 0.01) in out-of-hospital than in-hospital cardiac arrest and was significantly associated with shorter time from collapse to ECMO. The application of stringent ECPR criteria (n = 105) resulted in 38% of patients with favorable neurologic outcome.

Conclusions

ECPR was associated with intact neurological recovery in 19% of unselected cardiac arrest victims, with 38% favorable outcome if stringent selection criteria would have been applied.

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References

  1. Wong CX, Brown A, Lau DH et al (2019) Epidemiology of sudden cardiac death: global and regional perspectives. Heart Lung Circ 28(1):6–14

    Article  Google Scholar 

  2. Bobrow BJ, Spaite DW, Berg RA et al (2010) Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 304(13):1447–1454

    CAS  Article  Google Scholar 

  3. Perkins GD, Handley AJ, Koster RW et al (2015) European resuscitation council guidelines for resuscitation 2015: section 2. adult basic life support and automated external defibrillation. Resuscitation 95:81–99

    Article  Google Scholar 

  4. Reynolds JC, Grunau BE, Rittenberger JC et al (2016) Association between duration of resuscitation and favorable outcome after out-of-hospital cardiac arrest: implications for prolonging or terminating resuscitation. Circulation 134(25):2084–2094

    CAS  Article  Google Scholar 

  5. Girotra S, Nallamothu BK, Spertus JA et al (2012) Trends in survival after in-hospital cardiac arrest. N Engl J Med 367(20):1912–1920

    CAS  Article  Google Scholar 

  6. Reynolds JC, Frisch A, Rittenberger JC, Callaway CW (2013) Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation 128(23):2488–2494

    Article  Google Scholar 

  7. Richardson AS, Schmidt M, Bailey M et al (2017) ECMO cardio-pulmonary resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation 112:34–40

    Article  Google Scholar 

  8. Sakamoto T, Morimura N, Nagao K et al (2014) Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation 85(6):762–768

    Article  Google Scholar 

  9. Cardarelli MG, Young AJ, Griffith B (2009) Use of extracorporeal membrane oxygenation for adults in cardiac arrest (E-CPR): a meta-analysis of observational studies. ASAIO J 55(6):581–586

    Article  Google Scholar 

  10. Kagawa E, Inoue I, Kawagoe T et al (2010) Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation 81(8):968–973

    Article  Google Scholar 

  11. Chen Y-S, Chao A, Yu H-Y et al (2003) Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol 41(2):197–203

    Article  Google Scholar 

  12. Fagnoul D, Taccone FS, Belhaj A et al (2013) Extracorporeal life support associated with hypothermia and normoxemia in refractory cardiac arrest. Resuscitation 84(11):1519–1524

    Article  Google Scholar 

  13. Brooks SC, Anderson ML, Bruder E et al (2015) Part 6: alternative techniques and ancillary devices for cardiopulmonary resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(18 Suppl 2):S436–S443

    Article  Google Scholar 

  14. Avalli L, Maggioni E, Formica F et al (2012) Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience. Resuscitation 83(5):579–583

    Article  Google Scholar 

  15. Le Guen M, Nicolas-Robin A, Carreira S et al (2011) Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care 15(1):R29

    Article  Google Scholar 

  16. Sandroni C, D’Arrigo S, Callaway CW et al (2016) The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med 42(11):1661–1671

    Article  Google Scholar 

  17. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22(7):707–710

    CAS  Article  Google Scholar 

  18. Kellum JA, Lameire N; KDIGO AKI Guideline Work Group (2013) Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 17(1):204

    Article  Google Scholar 

  19. Henrion J (2012) Hypoxic hepatitis. Liver Int 32(7):1039–1052

    CAS  Article  Google Scholar 

  20. Taylor FB, Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH) (2001) Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 86(5):1327–1330

    CAS  Article  Google Scholar 

  21. Thuong M, Ruiz A, Evrard P et al (2016) New classification of donation after circulatory death donors definitions and terminology. Transpl Int 29(7):749–759

    Article  Google Scholar 

  22. Hasegawa K, Tsugawa Y, Camargo CA Jr, Hiraide A, Brown DF (2013) Regional variability in survival outcomes of out-of-hospital cardiac arrest: the All-Japan Utstein Registry. Resuscitation 84(8):1099–1107

    Article  Google Scholar 

  23. Berdowski J, Berg RA, Tijssen JG, Koster RW (2010) Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 81(11):1479–1487

    Article  Google Scholar 

  24. Yannopoulos D, Bartos JA, Martin C et al (2016) Minnesota resuscitation consortium’s advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation. J Am Heart Assoc 5:6

    Article  Google Scholar 

  25. Bougouin W, Dumas F, Lamhaut L et al (2019) Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz753

    Article  PubMed  Google Scholar 

  26. D’Arrigo S, Cacciola S, Dennis M et al (2017) Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation 121:62–70

    Article  Google Scholar 

  27. Debaty G, Babaz V, Durand M et al (2017) Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation 112:1–10

    Article  Google Scholar 

  28. Grunau B, Reynolds J, Scheuermeyer F et al (2016) Relationship between time-to-ROSC and survival in out-of-hospital cardiac arrest ECPR candidates: when is the best time to consider transport to hospital? Prehosp Emerg Care 20(5):615–622

    Article  Google Scholar 

  29. Taccone FS, Crippa IA, Dell’Anna AM, Scolletta S (2015) Neuroprotective strategies and neuroprognostication after cardiac arrest. Best Pract Res Clin Anaesthesiol 29(4):451–464

    Article  Google Scholar 

  30. Sandroni C, Dell’anna AM, Tujjar O, Geri G, Cariou A, Taccone FS (2016) Acute kidney injury after cardiac arrest: a systematic review and meta-analysis of clinical studies. Miner Anestesiol 82(9):989–999

    Google Scholar 

  31. Nobile L, Taccone FS, Szakmany T et al (2016) The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database. Crit Care 20(1):368

    Article  Google Scholar 

  32. Roberts BW, Kilgannon JH, Chansky ME et al (2013) Multiple organ dysfunction after return of spontaneous circulation in postcardiac arrest syndrome. Crit Care Med 41(6):1492–1501

    CAS  Article  Google Scholar 

  33. Iesu E, Franchi F, Zama Cavicchi F et al (2018) Acute liver dysfunction after cardiac arrest. PLoS One 13(11):e0206655

    Article  Google Scholar 

  34. Lee DS, Chung CR, Jeon K et al (2016) Survival after extracorporeal cardiopulmonary resuscitation on weekends in comparison with weekdays. Ann Thorac Surg 101(1):133–140

    Article  Google Scholar 

  35. Lie SA, Hwang NC (2019) Challenges of brain death and apnea testing in adult patients on extracorporeal membrane oxygenation—a review. J Cardiothorac Vasc Anesth 33(8):2266–2272

    Article  Google Scholar 

  36. Efendijev I, Folger D, Raj R et al (2018) Outcomes and healthcare-associated costs one year after intensive care-treated cardiac arrest. Resuscitation 131:128–134

    Article  Google Scholar 

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Funding

No funding was received for this study.

Author information

Author notes

  1. Dirk Lunz and Lorenzo Calabrò contributed as first authors.

Affiliations

  1. Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany

    Dirk Lunz

  2. Department of Cardiothoracic Anesthesia and Intensive Care, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Lorenzo Calabrò, Anna Maria Scandroglio & Federico Pappalardo

  3. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Cliniques Universitaires de Bruxelles (CUB) Erasme, Route de Lennik, 808, 1070, Brussels, Belgium

    Lorenzo Calabrò, Daniel Patricio, Jacques Creteur & Fabio Silvio Taccone

  4. UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Mirko Belliato & Enrico Contri

  5. ECMO Centre Karolinska, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

    Lars Mikael Broman

  6. Department of Internal Medicine II, Cardiology and Pneumology, Intensive Care, University Medical Center Regensburg, Regensburg, Germany

    Maximilian Malfertheiner

  7. Department of Perfusion, University Hospital Regensburg, Regensburg, Germany

    Alois Philipp

Authors
  1. Dirk Lunz
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  2. Lorenzo Calabrò
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  3. Mirko Belliato
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  4. Enrico Contri
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  6. Anna Maria Scandroglio
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  9. Jacques Creteur
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  10. Alois Philipp
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  11. Fabio Silvio Taccone
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  12. Federico Pappalardo
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Contributions

FST, MB, FP, LMB, and MW conceived the study protocol; FST, LMB, FP, MB, DL, and MW participated in the design and coordination of the study; LC, EC, AMS, DP, and AP collected study data; JC, MB, FP, LMB, and MW supervised data collection; FST, DL, LMB, FP, MW, JC, and DP participated in data interpretation; LC, EC, AMS, and AP were responsible for the literature search; FST, LMB, FP, MB, JC, DL, and MW drafted the present manuscript; LC, EC, AMS, DP, and AP revised the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Fabio Silvio Taccone.

Ethics declarations

Conflicts of interest

MB, LMB, FST, and FP received honoraria from Eurosets (Medolla, Italy). The other authors have no conflict of interest to disclose.

Ethical approval

Ethical approval was obtained by the Ethics Committee of each participating center. Hôpital Erasme: P2017/263—Fondazione IRCCS Policlinico San Matteo: Prot 3RIA2 2016)—University Hospital Regensburg: 17-426-160—San Raffaele Hospital: Prot OUT IMP 17072013—Karolinska Institutet: 2016/2447-31/4.

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Lunz, D., Calabrò, L., Belliato, M. et al. Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study. Intensive Care Med 46, 973–982 (2020). https://doi.org/10.1007/s00134-020-05926-6

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  • DOI: https://doi.org/10.1007/s00134-020-05926-6

Keywords

  • Cardiac arrest
  • ECPR
  • In-hospital
  • Out-of-hospital
  • Survival
  • Neurological outcome