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Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation.

ABSTRACT: PURPOSE:Caseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR. METHODS:Adult patients who received ECPR in our institution (2006-2016) were classified into groups 1, 2, and 3 (18-65, 65-75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge. RESULTS:In total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P?=?0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of?< 30, 30-60, and > 60 min, respectively (P?=?0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P?=?0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P?=?0.274). CONCLUSION:On emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome.

SUBMITTER: Yu HY

PROVIDER: S-EPMC6334728 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation.

Yu Hsi-Yu HY Wang Chih-Hsien CH Chi Nai-Hsin NH Huang Shu-Chien SC Chou Heng-Wen HW Chou Nai-Kuan NK Chen Yih-Sharng YS

Intensive care medicine 20181213 1

<h4>Purpose</h4>Caseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR.<h4>Methods</h4>Adult patients who received ECPR in our institution (2006-2016) were classified into groups 1, 2, and 3 (18-65, ...[more]

PMID: 30547322

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Project description:BackgroundLimited data exist about neurobehavioral outcomes of children treated with open-chest cardiopulmonary resuscitation (CPR). Our objective was to describe neurobehavioral outcomes 1 year after arrest among children who received open-chest CPR during in-hospital cardiac arrest and to explore factors associated with 1-year survival and survival with good neurobehavioral outcome.MethodsThe study is a secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital Trial. Fifty-six children who received open-chest CPR for in-hospital cardiac arrest were included. Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline before arrest and 12 months after arrest. Norms for VABS-II are 100 ± 15 points. Outcomes included 12-month survival, 12-month survival with VABS-II decreased by no more than 15 points from baseline, and 12-month survival with VABS-II of 70 or more points.ResultsOf 56 children receiving open-chest CPR, 49 (88%) were after cardiac surgery and 43 (77%) were younger than 1 year. Forty-four children (79%) were cannulated for extracorporeal membrane oxygenation (ECMO) during CPR or within 6 hours of return of spontaneous circulation. Thirty-three children (59%) survived to 12 months, 22 (41%) survived to 12 months with VABS-II decreased by no more than 15 points from baseline, and of the children with baseline VABS-II of 70 or more points 23 (51%) survived to 12 months with VABS-II of 70 or more points. On multivariable analyses, use of ECMO, renal replacement therapy, and higher maximum international normalized ratio were independently associated with lower 12-month survival with VABS-II of 70 or more points.ConclusionsApproximately one-half of children survived with good neurobehavioral outcome 1 year after open-chest CPR for in-hospital cardiac arrest. Use of ECMO and postarrest renal or hepatic dysfunction may be associated with worse neurobehavioral outcomes.

Project description:BackgroundThis systemic review aimed to explore the predictors of discharge and neurologic outcome of adult extracorporeal cardiopulmonary resuscitation (ECPR) to provide references for patient selection.MethodsElectronically searching of the Pubmed, Embase, Cochrane Library, and manual retrieval were done for clinical trials about predictors for adult ECPR which were published between January 2000 and January 2018 and included predictors for discharge and neurologic outcome. The literature was screened according to inclusion and exclusion criteria, the baseline information and interested outcomes were extracted. Two reviewers assessed the methodologic quality of the included studies and the quality of evidence for summary estimates independently. Pooled mean difference (MD) or odds ratio (OR) and 95% confidence interval (CI) were calculated by Review Manager Software 5.3. At last the quality of evidence for summary estimates was appraised according to Grading of Recommendations Assessment, Development, and Evaluation rating system.ResultsIn 16 studies, 1162 patients were enrolled. Out-of-hospital cardiac arrest (CA) (OR 0.58, 95% CI 0.36-0.93, P?=?.02), in-hospital CA (OR 1.73, 95% CI 1.08-2.77, P?=?.02), witnessed CA (OR 5.2, 95% CI 1.18-22.88, P?=?.01), bystander cardiopulmonary resuscitation (CPR) (OR 7.35, 95% CI 2.32-23.25, P?<?.01), initial shockable rhythm (OR 2.29, 95% CI 1.53-3.42, P?<?.01), 1st recorded nonshockable rhythm (OR 0.44, 95% CI 0.29-0.66, P?<?.01), CPR duration (MD -13.84?minutes, 95% CI -21 to -6.69, P?<?.0001), arrest-to-extracorporeal membrane oxygenation (ECMO) (MD -17.88?minutes, 95% CI -23.59 to -12.17, P?<?.01), PH (MD 0.14, 95% CI 0.08-0.21, P?<?.01), lactate (MD -3.66 mmol/L, 95% CI -7.15 to -0.17, P?=?.04), and percutaneous coronary intervention (PCI) (OR 1.63, 95% CI 1.02-2.58, P?=?.04)were identified as the survival predictors of ECPR. Shockable rhythm (OR 2.33, 95% CI 1.20-4.52, P?=?.01) and CPR duration (MD -9.85?minutes, 95% CI -15.71 to -3.99, P?=?.001) were identified as the neurologic outcome predictors of ECPR.ConclusionCurrent evidence showed that in-hospital CA, witnessed CA, bystander CPR, initial shockable rhythm, shorter CPR duration and arrest-to-ECMO duration, higher baseline PH, lower baseline lactate and PCI were favourable survival predictors of adult ECPR, and shockable rhythm and shorter CPR duration were good neurological outcome predictors of adult ECPR.

Project description:ObjectivesLess than half of the thousands of children who suffer in-hospital cardiac arrests annually survive, and neurologic injury is common among survivors. Hemodynamic-directed cardiopulmonary resuscitation improves short-term survival, but its impact on longer term survival and mitochondrial respiration-a potential neurotherapeutic target-remains unknown. The primary objectives of this study were to compare rates of 24-hour survival with favorable neurologic outcome after cardiac arrest treated with hemodynamic-directed cardiopulmonary resuscitation versus standard depth-guided cardiopulmonary resuscitation and to compare brain and heart mitochondrial respiration between groups 24 hours after resuscitation.DesignRandomized preclinical large animal trial.SettingA large animal resuscitation laboratory at a large academic children's hospital.SubjectsTwenty-eight 4-week-old female piglets (8-11 kg).InterventionsTwenty-two swine underwent 7 minutes of asphyxia followed by ventricular fibrillation and randomized treatment with either hemodynamic-directed cardiopulmonary resuscitation (n = 10; compression depth titrated to aortic systolic pressure of 90 mm Hg, vasopressors titrated to coronary perfusion pressure ≥ 20 mm Hg) or depth-guided cardiopulmonary resuscitation (n = 12; depth 1/3 chest diameter, epinephrine every 4 min). Six animals (sham group) underwent anesthesia and instrumentation without cardiac arrest. The primary outcomes were favorable neurologic outcome (swine Cerebral Performance Category ≤ 2) and mitochondrial maximal oxidative phosphorylation utilizing substrate for complex I and complex II (OXPHOSCI+CII) in the cerebral cortex and hippocampus.Measurements and main resultsFavorable neurologic outcome was more likely with hemodynamic-directed cardiopulmonary resuscitation (7/10) than depth-guided cardiopulmonary resuscitation (1/12; p = 0.006). Hemodynamic-directed cardiopulmonary resuscitation resulted in higher intra-arrest coronary perfusion pressure, aortic pressures, and brain tissue oxygenation. Hemodynamic-directed cardiopulmonary resuscitation resulted in higher OXPHOSCI+CII (pmol oxygen/s × mg/citrate synthase) in the cortex (6.00 ± 0.28 vs 3.88 ± 0.43; p < 0.05) and hippocampus (6.26 ± 0.67 vs 3.55 ± 0.65; p < 0.05) and higher complex I respiration (pmol oxygen/s × mg) in the right (20.62 ± 1.06 vs 15.88 ± 0.81; p < 0.05) and left ventricles (20.14 ± 1.40 vs 14.17 ± 1.53; p < 0.05).ConclusionsIn a model of asphyxia-associated pediatric cardiac arrest, hemodynamic-directed cardiopulmonary resuscitation increases rates of 24-hour survival with favorable neurologic outcome, intra-arrest hemodynamics, and cerebral and myocardial mitochondrial respiration.

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Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation.

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Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation.

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