Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2020

01-12-2020 | Cardiopulmonary Resuscitation | Original research

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Authors: Fu-Yuan Siao, Chun-Wen Chiu, Chun-Chieh Chiu, Yu-Jun Chang, Ying-Chen Chen, Yao-Li Chen, Yung-Kun Hsieh, Chu-Chung Chou, Hsu-Hen Yen

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2020

Login to get access

Abstract

Background

Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution.

Methods

This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model.

Results

The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flow Time, cardiac arrest Location, and initial cardiac arrest Rhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%, p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%, p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%, p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%, p = 0.0003) than the medium-risk and high-risk groups.

Conclusions

Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.
Literature
1.
Chiu CW, Yen HH, Chiu CC, Chen YC, Siao FY. Prolonged cardiac arrest: successful resuscitation with extracorporeal membrane oxygenation. Am J Emerg Med. 2013;31(11):1627 e1625–6.
2.
Chiu CC, Yen HH, Chen YL, Siao FY. Severe hyperkalemia with refractory ventricular fibrillation: successful resuscitation using extracorporeal membrane oxygenation. Am J Emerg Med. 2014;32(8):943 e945–6.
3.
Siao FY, Chiu CC, Chiu CW, Chen YC, Chen YL, Hsieh YK, Lee CH, Wu CT, Chou CC, Yen HH. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation. Resuscitation. 2015;92:70–6.PubMed
4.
Tonna JE, Selzman CH, Mallin MP, Smith BR, Youngquist ST, Koliopoulou A, Welt F, Stoddard KD, Nirula R, Barton R, et al. Development and implementation of a comprehensive, multidisciplinary emergency department extracorporeal membrane oxygenation program. Ann Emerg Med. 2017;70(1):32–40.PubMed
5.
Patricio D, Peluso L, Brasseur A, Lheureux O, Belliato M, Vincent JL, Creteur J, Taccone FS. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care. 2019;23(1):27.PubMedPubMedCentral
6.
Conseil francais de reanimation c, Societe francaise d'anesthesie et de r, Societe francaise de c, Societe francaise de chirurgie thoracique et c, Societe francaise de medecine du, Societe francaise de p, Groupe francophone de reanimation et d'urgence p, Societe francaise de p, Societe de reanimation de langue f. Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health. Ann Fr Anesth Reanim. 2009;28(2):182–90.
7.
Johnson NJ, Acker M, Hsu CH, Desai N, Vallabhajosyula P, Lazar S, Horak J, Wald J, McCarthy F, Rame E, et al. Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest. Resuscitation. 2014;85(11):1527–32.PubMed
8.
Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T, Muller T, Windisch W. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42(5):889–96.PubMed
9.
Pozzi M, Koffel C, Armoiry X, Pavlakovic I, Neidecker J, Prieur C, Bonnefoy E, Robin J, Obadia JF. Extracorporeal life support for refractory out-of-hospital cardiac arrest: should we still fight for? A single-Centre, 5-year experience. Int J Cardiol. 2016;204:70–6.PubMed
10.
Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, Hockings L, Shaw J, Duffy SJ, Burrell A, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015;86:88–94.PubMed
11.
Thiagarajan RR, Barbaro RP, Rycus PT, McMullan DM, Conrad SA, Fortenberry JD, Paden ML, centers Em. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(1):60–7.PubMed
12.
Brooks SC, Anderson ML, Bruder E, Daya MR, Gaffney A, Otto CW, Singer AJ, Thiagarajan RR, Travers AH. Part 6: alternative techniques and ancillary devices for cardiopulmonary resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S436–43.PubMed
13.
Henry B, Verbeek PR, Cheskes S. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: ethical considerations. Resuscitation. 2019;137:1–6.PubMed
14.
Bol ME, Suverein MM, Lorusso R, Delnoij TSR, Brandon Bravo Bruinsma GJ, Otterspoor L, Kuijpers M, Lam KY, APJ V, Elzo Kraemer CV, et al. Early initiation of extracorporeal life support in refractory out-of-hospital cardiac arrest: design and rationale of the INCEPTION trial. Am Heart J. 2018;210:58–68.PubMed
15.
Grunau B, Hornby L, Singal RK, Christenson J, Ortega-Deballon I, Shemie SD, Bashir J, Brooks SC, Callaway CW, Guadagno E, et al. Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: the state of the evidence and framework for application. Can J Cardiol. 2018;34(2):146–55.PubMed
16.
Rigamonti F, Montecucco F, Boroli F, Rey F, Gencer B, Cikirikcioglu M, Reverdin S, Carbone F, Noble S, Roffi M, et al. The peak of blood lactate during the first 24h predicts mortality in acute coronary syndrome patients under extracorporeal membrane oxygenation. Int J Cardiol. 2016;221:741–5.PubMed
17.
Yu HY, Wang CH, Chi NH, Huang SC, Chou HW, Chou NK, Chen YS. Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation. Intensive Care Med. 2019;45(1):44–54.PubMed
18.
Chen WC, Huang KY, Yao CW, Wu CF, Liang SJ, Li CH, Tu CY, Chen HJ. The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department. Crit Care. 2016;20(1):336.PubMedPubMedCentral
19.
Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246–56.PubMed
20.
Muller G, Flecher E, Lebreton G, Luyt CE, Trouillet JL, Brechot N, Schmidt M, Mastroianni C, Chastre J, Leprince P, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med. 2016;42(3):370–8.PubMed
21.
Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, Bouvaist H, Chavanon O, Maignan M, Bouzat P, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation. 2017;112:1–10.PubMed
22.
Zhang Q, Qi Z, Liu B, Li C. Predictors of survival and favorable neurological outcome in patients treated with targeted temperature management after cardiac arrest: a systematic review and meta-analysis. Heart Lung. 2018;47(6):602–9.PubMed
23.
Beyea MM, Tillmann BW, Iansavichene AE, Randhawa VK, Van Aarsen K, Nagpal AD. Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: a systematic review. Resuscitation. 2018;130:146–58.PubMed
24.
Huang HW, Chiu CC, Yen HH, Chen YL, Siao FY. Prolonged pulseless electrical activity: successful resuscitation using extracorporeal membrane oxygenation. Am J Emerg Med. 2015;33(3):474 e475–6.
25.
Bednarczyk JM, White CW, Ducas RA, Golian M, Nepomuceno R, Hiebert B, Bueddefeld D, Manji RA, Singal RK, Hussain F, et al. Resuscitative extracorporeal membrane oxygenation for in hospital cardiac arrest: a Canadian observational experience. Resuscitation. 2014;85(12):1713–9.PubMed
26.
27.
Trummer G, Foerster K, Buckberg GD, Benk C, Heilmann C, Mader I, Feuerhake F, Liakopoulos O, Brehm K, Beyersdorf F. Successful resuscitation after prolonged periods of cardiac arrest: a new field in cardiac surgery. J Thorac Cardiovasc Surg. 2010;139(5):1325–32 1332 e1321–1322.PubMed
28.
Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372(9638):554–61.PubMed
29.
Chan PS, Spertus JA, Krumholz HM, Berg RA, Li Y, Sasson C, Nallamothu BK. Get with the guidelines-resuscitation registry I: a validated prediction tool for initial survivors of in-hospital cardiac arrest. Arch Intern Med. 2012;172(12):947–53.PubMedPubMedCentral
30.
Komeyama S, Takagi K, Tsuboi H, Tsuboi S, Morita Y, Yoshida R, Kanzaki Y, Nagai H, Ikai Y, Furui K, et al. The early initiation of extracorporeal life support may improve the neurological outcome in adults with cardiac arrest due to cardiac events. Intern Med. 2019;58(10):1391–7.
31.
Wang CH, Chou NK, Becker LB, Lin JW, Yu HY, Chi NH, Hunag SC, Ko WJ, Wang SS, Tseng LJ, et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest--a comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation. 2014;85(9):1219–24.PubMed
32.
Tonna JE, Johnson NJ, Greenwood J, Gaieski DF, Shinar Z, Bellezo JM, Becker L, Shah AP, Youngquist ST, Mallin MP, et al. Practice characteristics of emergency department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: the current state of the art of emergency department extracorporeal membrane oxygenation (ED ECMO). Resuscitation. 2016;107:38–46.PubMedPubMedCentral
33.
Kayser RG, Ornato JP, Peberdy MA. American Heart Association National Registry of cardiopulmonary R: cardiac arrest in the emergency department: a report from the National Registry of cardiopulmonary resuscitation. Resuscitation. 2008;78(2):151–60.PubMed
34.
Wengenmayer T, Rombach S, Ramshorn F, Biever P, Bode C, Duerschmied D, Staudacher DL. Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care. 2017;21(1):157.PubMedPubMedCentral
35.
Otani T, Sawano H, Natsukawa T, Nakashima T, Oku H, Gon C, Takahagi M, Hayashi Y. Low-flow time is associated with a favorable neurological outcome in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation. J Crit Care. 2018;48:15–20.PubMed
36.
Ryu JA, Cho YH, Sung K, Choi SH, Yang JH, Choi JH, Lee DS, Yang JH. Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation. BMC Anesthesiol. 2015;15:26.PubMedPubMedCentral
37.
Park BW, Seo DC, Moon IK, Chung JW, Bang DW, Hyon MS, Kim SK, Chang WH, Youm W. Pulse pressure as a prognostic marker in patients receiving extracorporeal life support. Resuscitation. 2013;84(10):1404–8.PubMed
38.
Tseng LJ, Yu HY, Wang CH, Chi NH, Huang SC, Chou HW, Shih HC, Chou NK, Chen YS. Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation. J Clin Med. 2018;7(10):313.PubMedCentral
39.
Lee W, Kim Y, Choi H, Kim H, Lee S, Lee H, Chee H, Kim J, Hwang J, Lee S, et al. Advanced age as a predictor of survival and weaning in Venoarterial extracorporeal oxygenation: a retrospective observational study. Biomed Res Int. 2017;2017:3505784.PubMedPubMedCentral
40.
Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med. 2010;38(1):101–8.PubMed
41.
Yannopoulos D, Bartos JA, Raveendran G, Conterato M, Frascone RJ, Trembley A, John R, Connett J, Benditt DG, Lurie KG, et al. Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest. J Am Coll Cardiol. 2017;70(9):1109–17.PubMed
42.
Pabst D, Brehm CE. Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support? Am J Emerg Med. 2018;36(4):637–40.PubMed
43.
D'Arrigo S, Cacciola S, Dennis M, Jung C, Kagawa E, Antonelli M, Sandroni C. Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation. 2017;121:62–70.PubMed
44.
Megarbane B, Deye N, Aout M, Malissin I, Resiere D, Haouache H, Brun P, Haik W, Leprince P, Vicaut E, et al. Usefulness of routine laboratory parameters in the decision to treat refractory cardiac arrest with extracorporeal life support. Resuscitation. 2011;82(9):1154–61.PubMed
45.
Slottosch I, Liakopoulos O, Kuhn E, Scherner M, Deppe AC, Sabashnikov A, Mader N, Choi YH, Wippermann J, Wahlers T. Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock. J Crit Care. 2017;42:35–41.PubMed
Metadata
Title
Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?
Authors
Fu-Yuan Siao
Chun-Wen Chiu
Chun-Chieh Chiu
Yu-Jun Chang
Ying-Chen Chen
Yao-Li Chen
Yung-Kun Hsieh
Chu-Chung Chou
Hsu-Hen Yen
Publication date
01-12-2020
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-020-00753-6

Other articles of this Issue 1/2020

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2020 Go to the issue

Original research

Real-time AI prediction for major adverse cardiac events in emergency department patients with chest pain

Original research

Validation of a point-of-care capillary lactate measuring device (Lactate Pro 2)

Original research

Association of helicopter transportation and improved mortality for patients with major trauma in the northern French Alps trauma system: an observational study based on the TRENAU registry

Original research

Exploiting an early warning Nomogram for predicting the risk of ICU admission in patients with COVID-19: a multi-center study in China

Original research

Pre-hospital blood transfusion – an ESA survey of European practice

Original research

Consistency and variability in human performance during simulate infant CPR: a reliability study