Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time
Objectives: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used due to its beneficial outcomes and results compared to conventional CPR. Cardiac arrests can be categorized depending on location: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-06-01
|
| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266652042400064X |
| _version_ | 1827231489319763968 |
|---|---|
| author | Christopher Gaisendrees Georg Schlachtenberger Lynn Müller Deborah Jaeger Ilija Djordjevic Ihor Krasivskyi Ahmed Elderia Sebastian Walter Mattias Vollmer Carolyn Weber Maximilian Luehr Thorsten Wahlers |
| author_facet | Christopher Gaisendrees Georg Schlachtenberger Lynn Müller Deborah Jaeger Ilija Djordjevic Ihor Krasivskyi Ahmed Elderia Sebastian Walter Mattias Vollmer Carolyn Weber Maximilian Luehr Thorsten Wahlers |
| author_sort | Christopher Gaisendrees |
| collection | DOAJ |
| description | Objectives: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used due to its beneficial outcomes and results compared to conventional CPR. Cardiac arrests can be categorized depending on location: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, studies comparing the two are scarce, especially in comparing outcomes after ECPR. This study compared patient characteristics, cardiac arrest characteristics, and outcomes. Methods: Between 2016 and 2022, patients who underwent ECPR for cardiac arrest at our institution were retrospectively analyzed, depending on the arrest location: IHCA and OHCA. We compared periprocedural characteristics and used multinomial regression analysis to indicate parameters contributing to a favorable outcome. Results: A total of n = 157 patients (100%) were analyzed (OHCA = 91; IHCA = 66). Upon admission, OHCA patients were younger (53.2 ± 12.4 vs. 59.2 ± 12.6 years) and predominantly male (91.1% vs. 66.7%, p=<0.001). The low-flow time was significantly shorter in IHCA patients (41.1 ± 27.4 mins) compared to OHCA (63.6 ± 25.1 mins). Despite this significant difference, in-hospital mortality was not significantly different in both groups (IHCA = 72.7% vs. OHCA = 76.9%, p = 0.31). Both groups' survival-to-discharge factors were CPR duration, low flow time, and lactate values upon ECMO initiation. Conclusion: Survival-to-discharge for ECPR in IHCA and OHCA was around 25%, and there was no statistically significant difference between the two cohorts. Factors predicting survival were lower lactate levels before cannulation and lower low-flow time. As such, OHCA patients seem to tolerate longer low-flow times and thus metabolic impairments compared to IHCA patients and may be considered for ECMO cannulation on a broader time span than IHCA. |
| first_indexed | 2024-04-24T20:25:24Z |
| format | Article |
| id | doaj.art-f248e9697929494e9ef8951c29983865 |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2025-03-21T19:02:21Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-f248e9697929494e9ef8951c299838652024-06-05T04:41:16ZengElsevierResuscitation Plus2666-52042024-06-0118100613Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against timeChristopher Gaisendrees0Georg Schlachtenberger1Lynn Müller2Deborah Jaeger3Ilija Djordjevic4Ihor Krasivskyi5Ahmed Elderia6Sebastian Walter7Mattias Vollmer8Carolyn Weber9Maximilian Luehr10Thorsten Wahlers11Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany; Corresponding author at: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.Department of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyINSERM U 1116, University of Lorraine, 54500 Vandœuvre-lès-Nancy, FranceDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Orthopedic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyDepartment of Cardiothoracic Surgery, University Hospital of Cologne, GermanyObjectives: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used due to its beneficial outcomes and results compared to conventional CPR. Cardiac arrests can be categorized depending on location: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, studies comparing the two are scarce, especially in comparing outcomes after ECPR. This study compared patient characteristics, cardiac arrest characteristics, and outcomes. Methods: Between 2016 and 2022, patients who underwent ECPR for cardiac arrest at our institution were retrospectively analyzed, depending on the arrest location: IHCA and OHCA. We compared periprocedural characteristics and used multinomial regression analysis to indicate parameters contributing to a favorable outcome. Results: A total of n = 157 patients (100%) were analyzed (OHCA = 91; IHCA = 66). Upon admission, OHCA patients were younger (53.2 ± 12.4 vs. 59.2 ± 12.6 years) and predominantly male (91.1% vs. 66.7%, p=<0.001). The low-flow time was significantly shorter in IHCA patients (41.1 ± 27.4 mins) compared to OHCA (63.6 ± 25.1 mins). Despite this significant difference, in-hospital mortality was not significantly different in both groups (IHCA = 72.7% vs. OHCA = 76.9%, p = 0.31). Both groups' survival-to-discharge factors were CPR duration, low flow time, and lactate values upon ECMO initiation. Conclusion: Survival-to-discharge for ECPR in IHCA and OHCA was around 25%, and there was no statistically significant difference between the two cohorts. Factors predicting survival were lower lactate levels before cannulation and lower low-flow time. As such, OHCA patients seem to tolerate longer low-flow times and thus metabolic impairments compared to IHCA patients and may be considered for ECMO cannulation on a broader time span than IHCA.http://www.sciencedirect.com/science/article/pii/S266652042400064XIHCAOHCA ECMOMechanical circulatory supportCardiogenic shockECPR |
| spellingShingle | Christopher Gaisendrees Georg Schlachtenberger Lynn Müller Deborah Jaeger Ilija Djordjevic Ihor Krasivskyi Ahmed Elderia Sebastian Walter Mattias Vollmer Carolyn Weber Maximilian Luehr Thorsten Wahlers Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time Resuscitation Plus IHCA OHCA ECMO Mechanical circulatory support Cardiogenic shock ECPR |
| title | Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time |
| title_full | Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time |
| title_fullStr | Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time |
| title_full_unstemmed | Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time |
| title_short | Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: The race against time |
| title_sort | extracorporeal cardiopulmonary resuscitation for in and out of hospital cardiac arrest the race against time |
| topic | IHCA OHCA ECMO Mechanical circulatory support Cardiogenic shock ECPR |
| url | http://www.sciencedirect.com/science/article/pii/S266652042400064X |
| work_keys_str_mv | AT christophergaisendrees extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT georgschlachtenberger extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT lynnmuller extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT deborahjaeger extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT ilijadjordjevic extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT ihorkrasivskyi extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT ahmedelderia extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT sebastianwalter extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT mattiasvollmer extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT carolynweber extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT maximilianluehr extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime AT thorstenwahlers extracorporealcardiopulmonaryresuscitationforinandoutofhospitalcardiacarresttheraceagainsttime |