Mark Dennis1, Peter McCanny2, Mario D'Souza3, Paul Forrest4, Brian Burns5, David A Lowe2, David Gattas6, Sean Scott7, Paul Bannon8, Emily Granger9, Roger Pye2, Richard Totaro6. 1. Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: mden5273@uni.sydney.edu.au. 2. Department of Intensive Care, St Vincent's Hospital, Sydney, Australia. 3. Sydney Local Health District, Clinical Research Centre, Australia. 4. Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiothoracic Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia. 5. Sydney Medical School, University of Sydney, Sydney, Australia; Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance Service, Australia. 6. Sydney Medical School, University of Sydney, Sydney, Australia; Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia. 7. Department of Emergency Medicine, St Vincent's Hospital, Sydney, Australia. 8. Sydney Medical School, University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 9. Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia.
Abstract
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.
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.
Authors: Mia Bertic; Mali Worme; Farid Foroutan; Vivek Rao; Heather Ross; Filio Billia; Ana C Alba Journal: J Cardiovasc Transl Res Date: 2022-02-22 Impact factor: 3.216
Authors: Hyoung Soo Kim; Dae Young Cheon; Sang Ook Ha; Sang Jin Han; Hyun-Sook Kim; Sun Hee Lee; Sung Gyun Kim; Sunghoon Park Journal: J Thorac Dis Date: 2018-03 Impact factor: 2.895