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Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support under extracorporeal cardiopulmonary resuscitation (eCPR) is the last option and may be offered to selected patients. Several factors predict outcome in these patients, including initial heart rhythm, comorbidities, and b...

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Autores principales: Wengenmayer, Tobias, Rombach, Stephan, Ramshorn, Florian, Biever, Paul, Bode, Christoph, Duerschmied, Daniel, Staudacher, Dawid L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480193/
https://www.ncbi.nlm.nih.gov/pubmed/28637497
http://dx.doi.org/10.1186/s13054-017-1744-8
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author Wengenmayer, Tobias
Rombach, Stephan
Ramshorn, Florian
Biever, Paul
Bode, Christoph
Duerschmied, Daniel
Staudacher, Dawid L.
author_facet Wengenmayer, Tobias
Rombach, Stephan
Ramshorn, Florian
Biever, Paul
Bode, Christoph
Duerschmied, Daniel
Staudacher, Dawid L.
author_sort Wengenmayer, Tobias
collection PubMed
description BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support under extracorporeal cardiopulmonary resuscitation (eCPR) is the last option and may be offered to selected patients. Several factors predict outcome in these patients, including initial heart rhythm, comorbidities, and bystander cardiopulmonary resuscitation (CPR). We evaluated outcomes of all VA-ECMO patients treated within the last 5 years at our center in respect to low-flow duration during CPR. METHODS: We report retrospective registry data on all patients with eCPR treated at a university hospital between October 2010 and May 2016. RESULTS: A total of 133 patients (mean age 58.7 ± 2.6 years, Simplified Acute Physiology Score II score at admission 48.1 ± 3.4) were included in the analysis. The indication for eCPR was either in-hospital or out-of-hospital cardiac arrest without return of spontaneous circulation (n = 74 and 59, respectively). There was a significant difference in survival rates between groups (eCPR in-hospital cardiac arrest [IHCA] 18.9%, eCPR out-of-hospital cardiac arrest [OHCA] 8.5%; p < 0.042). Mean low-flow duration (i.e., duration of mechanical CPR until VA-ECMO support) was 59.6 ± 5.0 minutes in all patients and significantly shorter in IHCA patients than in OHCA patients (49.6 ± 5.9 vs. 72.2 ± 7.4 minutes, p = 0.001). Low-flow time strongly correlated with survival (p < 0.001) and was an independent predictor of mortality. CONCLUSIONS: Time to full support is an important and alterable predictor of patient survival in eCPR, suggesting that VA-ECMO therapy should be established as fast as possible in the selected patients destined for eCPR. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1744-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-54801932017-06-23 Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR) Wengenmayer, Tobias Rombach, Stephan Ramshorn, Florian Biever, Paul Bode, Christoph Duerschmied, Daniel Staudacher, Dawid L. Crit Care Research BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support under extracorporeal cardiopulmonary resuscitation (eCPR) is the last option and may be offered to selected patients. Several factors predict outcome in these patients, including initial heart rhythm, comorbidities, and bystander cardiopulmonary resuscitation (CPR). We evaluated outcomes of all VA-ECMO patients treated within the last 5 years at our center in respect to low-flow duration during CPR. METHODS: We report retrospective registry data on all patients with eCPR treated at a university hospital between October 2010 and May 2016. RESULTS: A total of 133 patients (mean age 58.7 ± 2.6 years, Simplified Acute Physiology Score II score at admission 48.1 ± 3.4) were included in the analysis. The indication for eCPR was either in-hospital or out-of-hospital cardiac arrest without return of spontaneous circulation (n = 74 and 59, respectively). There was a significant difference in survival rates between groups (eCPR in-hospital cardiac arrest [IHCA] 18.9%, eCPR out-of-hospital cardiac arrest [OHCA] 8.5%; p < 0.042). Mean low-flow duration (i.e., duration of mechanical CPR until VA-ECMO support) was 59.6 ± 5.0 minutes in all patients and significantly shorter in IHCA patients than in OHCA patients (49.6 ± 5.9 vs. 72.2 ± 7.4 minutes, p = 0.001). Low-flow time strongly correlated with survival (p < 0.001) and was an independent predictor of mortality. CONCLUSIONS: Time to full support is an important and alterable predictor of patient survival in eCPR, suggesting that VA-ECMO therapy should be established as fast as possible in the selected patients destined for eCPR. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1744-8) contains supplementary material, which is available to authorized users. BioMed Central 2017-06-22 /pmc/articles/PMC5480193/ /pubmed/28637497 http://dx.doi.org/10.1186/s13054-017-1744-8 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Wengenmayer, Tobias
Rombach, Stephan
Ramshorn, Florian
Biever, Paul
Bode, Christoph
Duerschmied, Daniel
Staudacher, Dawid L.
Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)
title Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)
title_full Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)
title_fullStr Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)
title_full_unstemmed Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)
title_short Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)
title_sort influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (ecpr)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480193/
https://www.ncbi.nlm.nih.gov/pubmed/28637497
http://dx.doi.org/10.1186/s13054-017-1744-8
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