Guillaume Debaty1, Valentin Babaz2, Michel Durand3, Lucie Gaide-Chevronnay3, Emmanuel Fournel3, Marc Blancher2, Hélène Bouvaist4, Olivier Chavanon5, Maxime Maignan6, Pierre Bouzat7, Pierre Albaladejo8, José Labarère9. 1. University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France. Electronic address: gdebaty@gmail.com. 2. Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France. 3. Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France. 4. Department of Cardiology, University Hospital of Grenoble Alps, Grenoble, France. 5. Department of Cardiac Surgery, University Hospital of Grenoble Alps, Grenoble, France; HP2 Laboratory, INSERM U 1042, Grenoble, France. 6. Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France; HP2 Laboratory, INSERM U 1042, Grenoble, France. 7. Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France; University Grenoble Alps, Grenoble Institut des Neurosciences, Grenoble F-38042, France. 8. University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France. 9. University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Quality of Care Unit, INSERM CIC1406, University Hospital of Grenoble Alps, Grenoble, France.
Abstract
PURPOSE: Association estimates between baseline characteristics and outcomes are imprecise and inconsistent among extracorporeal cardiopulmonary resuscitation (ECPR) recipients following refractory out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis aimed to investigate the prognostic significance of pre-specified characteristics for OHCA treated with ECPR. METHODS: The Medline electronic database was searched via PubMed for articles published from January 2000 to September 2016. The electronic search was supplemented by scanning the reference lists of retrieved articles and contacting field experts. Eligible studies were historical and prospective cohort studies of adult patients undergoing ECPR following OHCA. RESULTS: Fifteen primary studies were included, totaling 841 participants. The median prevalence of the primary outcome (i.e., short- or long-term survival for five studies and cerebral performance for ten studies) was 15% (range, 0-50%). The primary outcome was associated with an increased odds ratio of initial shockable cardiac rhythm (2.20; 95% confidence interval [CI], 1.30-3.72; P=0.003), shorter low-flow duration (geometric mean ratio, 0.90; 95% CI, 0.81-0.99; P=0.04), higher arterial pH value (difference, 0.12; 95% CI, 0.03-0.22; P=0.01) and lower serum lactate concentration (difference, -3.52mmol/L; 95% CI, -5.05 to -1.99; P<0.001). No significant association was found between the primary outcome and patient age (the odds of female gender and bystander CPR attempt. CONCLUSION: Observational evidence from published primary studies indicates that shorter low-flow duration, shockable cardiac rhythm, higher arterial pH value and lower serum lactate concentration on hospital admission are associated with better outcomes for ECPR recipients after OHCA.
PURPOSE: Association estimates between baseline characteristics and outcomes are imprecise and inconsistent among extracorporeal cardiopulmonary resuscitation (ECPR) recipients following refractory out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis aimed to investigate the prognostic significance of pre-specified characteristics for OHCA treated with ECPR. METHODS: The Medline electronic database was searched via PubMed for articles published from January 2000 to September 2016. The electronic search was supplemented by scanning the reference lists of retrieved articles and contacting field experts. Eligible studies were historical and prospective cohort studies of adult patients undergoing ECPR following OHCA. RESULTS: Fifteen primary studies were included, totaling 841 participants. The median prevalence of the primary outcome (i.e., short- or long-term survival for five studies and cerebral performance for ten studies) was 15% (range, 0-50%). The primary outcome was associated with an increased odds ratio of initial shockable cardiac rhythm (2.20; 95% confidence interval [CI], 1.30-3.72; P=0.003), shorter low-flow duration (geometric mean ratio, 0.90; 95% CI, 0.81-0.99; P=0.04), higher arterial pH value (difference, 0.12; 95% CI, 0.03-0.22; P=0.01) and lower serum lactate concentration (difference, -3.52mmol/L; 95% CI, -5.05 to -1.99; P<0.001). No significant association was found between the primary outcome and patient age (the odds of female gender and bystander CPR attempt. CONCLUSION: Observational evidence from published primary studies indicates that shorter low-flow duration, shockable cardiac rhythm, higher arterial pH value and lower serum lactate concentration on hospital admission are associated with better outcomes for ECPR recipients after OHCA.
Authors: Guido Michels; Tobias Wengenmayer; Christian Hagl; Christian Dohmen; Bernd W Böttiger; Johann Bauersachs; Andreas Markewitz; Adrian Bauer; Jan-Thorsten Gräsner; Roman Pfister; Alexander Ghanem; Hans-Jörg Busch; Uwe Kreimeier; Andreas Beckmann; Matthias Fischer; Clemens Kill; Uwe Janssens; Stefan Kluge; Frank Born; Hans Martin Hoffmeister; Michael Preusch; Udo Boeken; Reimer Riessen; Holger Thiele Journal: Clin Res Cardiol Date: 2018-09-04 Impact factor: 5.460
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Med Klin Intensivmed Notfmed Date: 2018-09 Impact factor: 0.840
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Anaesthesist Date: 2018-08 Impact factor: 1.041