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Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the e...

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Autores principales: Zotzmann, Viviane, Lang, Corinna N., Bemtgen, Xavier, Jäckel, Markus, Fluegler, Annabelle, Rilinger, Jonathan, Benk, Christoph, Bode, Christoph, Supady, Alexander, Wengenmayer, Tobias, Staudacher, Dawid L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068242/
https://www.ncbi.nlm.nih.gov/pubmed/33917888
http://dx.doi.org/10.3390/membranes11040270
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author Zotzmann, Viviane
Lang, Corinna N.
Bemtgen, Xavier
Jäckel, Markus
Fluegler, Annabelle
Rilinger, Jonathan
Benk, Christoph
Bode, Christoph
Supady, Alexander
Wengenmayer, Tobias
Staudacher, Dawid L.
author_facet Zotzmann, Viviane
Lang, Corinna N.
Bemtgen, Xavier
Jäckel, Markus
Fluegler, Annabelle
Rilinger, Jonathan
Benk, Christoph
Bode, Christoph
Supady, Alexander
Wengenmayer, Tobias
Staudacher, Dawid L.
author_sort Zotzmann, Viviane
collection PubMed
description Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.
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spelling pubmed-80682422021-04-25 Mode of Death after Extracorporeal Cardiopulmonary Resuscitation Zotzmann, Viviane Lang, Corinna N. Bemtgen, Xavier Jäckel, Markus Fluegler, Annabelle Rilinger, Jonathan Benk, Christoph Bode, Christoph Supady, Alexander Wengenmayer, Tobias Staudacher, Dawid L. Membranes (Basel) Article Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients. MDPI 2021-04-08 /pmc/articles/PMC8068242/ /pubmed/33917888 http://dx.doi.org/10.3390/membranes11040270 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zotzmann, Viviane
Lang, Corinna N.
Bemtgen, Xavier
Jäckel, Markus
Fluegler, Annabelle
Rilinger, Jonathan
Benk, Christoph
Bode, Christoph
Supady, Alexander
Wengenmayer, Tobias
Staudacher, Dawid L.
Mode of Death after Extracorporeal Cardiopulmonary Resuscitation
title Mode of Death after Extracorporeal Cardiopulmonary Resuscitation
title_full Mode of Death after Extracorporeal Cardiopulmonary Resuscitation
title_fullStr Mode of Death after Extracorporeal Cardiopulmonary Resuscitation
title_full_unstemmed Mode of Death after Extracorporeal Cardiopulmonary Resuscitation
title_short Mode of Death after Extracorporeal Cardiopulmonary Resuscitation
title_sort mode of death after extracorporeal cardiopulmonary resuscitation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068242/
https://www.ncbi.nlm.nih.gov/pubmed/33917888
http://dx.doi.org/10.3390/membranes11040270
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