Ryoung-Eun Ko1, Jeong-Am Ryu1, Yang Hyun Cho2, Kiick Sung2, Kyeongman Jeon3, Gee Young Suh3, Taek Kyu Park4, Joo Myung Lee4, Young Bin Song4, Joo-Yong Hahn4, Jin-Ho Choi4, Seung-Hyuk Choi4, Hyeon-Cheol Gwon4, Keumhee C Carriere5, Joonghyun Ahn6, Jeong Hoon Yang7. 1. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 3. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 5. Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada. 6. Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea. 7. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jhysmc@gmail.com.
Abstract
BACKGROUND: Limited data is available on the association between low-flow time and neurologic outcome according to the initial arrest rhythm in patients underwent extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: Between September 2004 and December 2018, 294 patients with in-hospital cardiac arrest (IHCA) were included in this analysis. We classified the patients into asystole (n = 42), pulseless electrical activity (PEA, n = 163) and shockable rhythm (n = 89) according to their initial rhythm. Primary outcome was poor neurologic outcome defined as Cerebral Performance Categories scores of 3, 4, and 5. RESULTS: One-hundred ninety IHCA patients (64.6%) had poor neurologic outcomes. There was significantly worse neurologic outcomes among IHCA patients according to their initial rhythm (asystole [88.1%], PEA [66.3%], and shockable rhythm [50.6%], p < 0.001). The PEA group and the shockable rhythm group showed a significant association between low-flow time and neurologic outcomes while this relationship was not observed in the asystole group: PEA [ρ = 0.224, p = 0.005], shockable rhythm [ρ = 0.298, p = 0.006]), and asystole [ρ = -0.091, p = 0.590]. The best discriminative CPR to pump-on time for neurologic outcome was 22 min in the PEA group (area under the curve 0.687, 95% confidence interval [CI] 0.610-0.758, p < 0.001) and 46 min in the shockable rhythm group (area under the curve 0.671, 95% CI 0.593-0.743, p < 0.001). CONCLUSIONS: The effect of interplay between arrest rhythm and low-flow time might be helpful for decisions about team activation and management for ECPR and could provide information for early neurologic prognosis.
BACKGROUND: Limited data is available on the association between low-flow time and neurologic outcome according to the initial arrest rhythm in patients underwent extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: Between September 2004 and December 2018, 294 patients with in-hospital cardiac arrest (IHCA) were included in this analysis. We classified the patients into asystole (n = 42), pulseless electrical activity (PEA, n = 163) and shockable rhythm (n = 89) according to their initial rhythm. Primary outcome was poor neurologic outcome defined as Cerebral Performance Categories scores of 3, 4, and 5. RESULTS: One-hundred ninety IHCA patients (64.6%) had poor neurologic outcomes. There was significantly worse neurologic outcomes among IHCA patients according to their initial rhythm (asystole [88.1%], PEA [66.3%], and shockable rhythm [50.6%], p < 0.001). The PEA group and the shockable rhythm group showed a significant association between low-flow time and neurologic outcomes while this relationship was not observed in the asystole group: PEA [ρ = 0.224, p = 0.005], shockable rhythm [ρ = 0.298, p = 0.006]), and asystole [ρ = -0.091, p = 0.590]. The best discriminative CPR to pump-on time for neurologic outcome was 22 min in the PEA group (area under the curve 0.687, 95% confidence interval [CI] 0.610-0.758, p < 0.001) and 46 min in the shockable rhythm group (area under the curve 0.671, 95% CI 0.593-0.743, p < 0.001). CONCLUSIONS: The effect of interplay between arrest rhythm and low-flow time might be helpful for decisions about team activation and management for ECPR and could provide information for early neurologic prognosis.
Authors: Yun Im Lee; Min Goo Kang; Ryoung-Eun Ko; Taek Kyu Park; Chi Ryang Chung; Yang Hyun Cho; Kyeongman Jeon; Gee Young Suh; Jeong Hoon Yang Journal: J Clin Med Date: 2020-09-16 Impact factor: 4.241
Authors: Ryoung-Eun Ko; Kyungmin Huh; Dong-Hoon Kim; Soo Jin Na; Chi Ryang Chung; Yang Hyun Cho; Kyeongman Jeon; Gee Young Suh; Jeong Hoon Yang Journal: PLoS One Date: 2020-12-23 Impact factor: 3.240
Authors: Arthur S Slutsky; Alain Combes; Daniel Brodie; Darryl Abrams; Graeme MacLaren; Roberto Lorusso; Susanna Price; Demetris Yannopoulos; Leen Vercaemst; Jan Bělohlávek; Fabio S Taccone; Nadia Aissaoui; Kiran Shekar; A Reshad Garan; Nir Uriel; Joseph E Tonna; Jae Seung Jung; Koji Takeda; Yih-Sharng Chen Journal: Intensive Care Med Date: 2021-09-10 Impact factor: 17.440