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Extracorporeal life support following out-of-hospital refractory cardiac arrest
INTRODUCTION: Extracorporeal life support (ECLS) has recently shown encouraging results in the resuscitation of in-hospital (IH) refractory cardiac arrest. We assessed the use of ECLS following out-of-hospital (OH) refractory cardiac arrest. METHODS: We evaluated 51 consecutive patients who experien...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222065/ https://www.ncbi.nlm.nih.gov/pubmed/21244674 http://dx.doi.org/10.1186/cc9976 |
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author | Le Guen, Morgan Nicolas-Robin, Armelle Carreira, Serge Raux, Mathieu Leprince, Pascal Riou, Bruno Langeron, Olivier |
author_facet | Le Guen, Morgan Nicolas-Robin, Armelle Carreira, Serge Raux, Mathieu Leprince, Pascal Riou, Bruno Langeron, Olivier |
author_sort | Le Guen, Morgan |
collection | PubMed |
description | INTRODUCTION: Extracorporeal life support (ECLS) has recently shown encouraging results in the resuscitation of in-hospital (IH) refractory cardiac arrest. We assessed the use of ECLS following out-of-hospital (OH) refractory cardiac arrest. METHODS: We evaluated 51 consecutive patients who experienced witnessed OH refractory cardiac arrest and received automated chest compression and ECLS upon arrival in the hospital. Patients with preexisting severe hypothermia who experienced IH cardiac arrest were excluded. A femorofemoral ECLS was set up on admission to the hospital by a mobile cardiothoracic surgical team. RESULTS: Fifty-one patients were included (mean age, 42 ± 15 years). The median delays from cardiac arrest to cardiopulmonary resuscitation and ECLS were, respectively, 3 minutes (25th to 75th interquartile range, 1 to 7) and 120 minutes (25th to 75th interquartile range, 102-149). Initial rhythm was ventricular fibrillation in 32 patients (63%), asystole in 15 patients (29%) patients and pulseless rhythm in 4 patients (8%). ECLS failed in 9 patients (18%). Only two patients (4%) (95% confidence interval, 1% to 13%) were alive at day 28 with a favourable neurological outcome. There was a significant correlation (r = 0.36, P = 0.01) between blood lactate and delay between cardiac arrest and onset of ECLS, but not with arterial pH or blood potassium level. Deaths were the consequence of multiorgan failure (n = 43; 47%), brain death (n = 10; 20%) and refractory hemorrhagic shock (n = 7; 14%), and most patients (n = 46; 90%) died within 48 hours. CONCLUSIONS: This poor outcome suggests that the use of ECLS should be more restricted following OH refractory cardiac arrest. |
format | Online Article Text |
id | pubmed-3222065 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-32220652011-11-22 Extracorporeal life support following out-of-hospital refractory cardiac arrest Le Guen, Morgan Nicolas-Robin, Armelle Carreira, Serge Raux, Mathieu Leprince, Pascal Riou, Bruno Langeron, Olivier Crit Care Research INTRODUCTION: Extracorporeal life support (ECLS) has recently shown encouraging results in the resuscitation of in-hospital (IH) refractory cardiac arrest. We assessed the use of ECLS following out-of-hospital (OH) refractory cardiac arrest. METHODS: We evaluated 51 consecutive patients who experienced witnessed OH refractory cardiac arrest and received automated chest compression and ECLS upon arrival in the hospital. Patients with preexisting severe hypothermia who experienced IH cardiac arrest were excluded. A femorofemoral ECLS was set up on admission to the hospital by a mobile cardiothoracic surgical team. RESULTS: Fifty-one patients were included (mean age, 42 ± 15 years). The median delays from cardiac arrest to cardiopulmonary resuscitation and ECLS were, respectively, 3 minutes (25th to 75th interquartile range, 1 to 7) and 120 minutes (25th to 75th interquartile range, 102-149). Initial rhythm was ventricular fibrillation in 32 patients (63%), asystole in 15 patients (29%) patients and pulseless rhythm in 4 patients (8%). ECLS failed in 9 patients (18%). Only two patients (4%) (95% confidence interval, 1% to 13%) were alive at day 28 with a favourable neurological outcome. There was a significant correlation (r = 0.36, P = 0.01) between blood lactate and delay between cardiac arrest and onset of ECLS, but not with arterial pH or blood potassium level. Deaths were the consequence of multiorgan failure (n = 43; 47%), brain death (n = 10; 20%) and refractory hemorrhagic shock (n = 7; 14%), and most patients (n = 46; 90%) died within 48 hours. CONCLUSIONS: This poor outcome suggests that the use of ECLS should be more restricted following OH refractory cardiac arrest. BioMed Central 2011 2011-01-18 /pmc/articles/PMC3222065/ /pubmed/21244674 http://dx.doi.org/10.1186/cc9976 Text en Copyright ©2011 Le Guen et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Le Guen, Morgan Nicolas-Robin, Armelle Carreira, Serge Raux, Mathieu Leprince, Pascal Riou, Bruno Langeron, Olivier Extracorporeal life support following out-of-hospital refractory cardiac arrest |
title | Extracorporeal life support following out-of-hospital refractory cardiac arrest |
title_full | Extracorporeal life support following out-of-hospital refractory cardiac arrest |
title_fullStr | Extracorporeal life support following out-of-hospital refractory cardiac arrest |
title_full_unstemmed | Extracorporeal life support following out-of-hospital refractory cardiac arrest |
title_short | Extracorporeal life support following out-of-hospital refractory cardiac arrest |
title_sort | extracorporeal life support following out-of-hospital refractory cardiac arrest |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222065/ https://www.ncbi.nlm.nih.gov/pubmed/21244674 http://dx.doi.org/10.1186/cc9976 |
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