Impact of extracorporeal CPR with transcatheter heart pump support (ECPELLA) on improvement of short-term survival and neurological outcome in patients with refractory cardiac arrest – A single-site retrospective cohort study

AIM: Extracorporeal cardiopulmonary resuscitation (E-CPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest. Although VA-ECMO preserves end-organ perfusion, it may affect left ventricular (LV) recovery due to increased LV loa...

Descripción completa

Detalles Bibliográficos
Autores principales: Unoki, Takashi, Kamentani, Motoko, Nakayama, Tomoko, Tamura, Yudai, Konami, Yutaka, Suzuyama, Hiroto, Inoue, Masayuki, Yamamuro, Megumi, Taguchi, Eiji, Sawamura, Tadashi, Nakao, Koichi, Sakamoto, Tomohiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Clinical Paper
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127400/
https://www.ncbi.nlm.nih.gov/pubmed/35620182
http://dx.doi.org/10.1016/j.resplu.2022.100244
Descripción
Sumario:AIM: Extracorporeal cardiopulmonary resuscitation (E-CPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest. Although VA-ECMO preserves end-organ perfusion, it may affect left ventricular (LV) recovery due to increased LV load. An emerging treatment modality, ECPELLA, which combines VA-ECMO and a transcatheter heart pump, Impella, can simultaneously provide circulatory support and LV unloading. In this single-site cohort study, we assessed impact of ECPELLA support on clinical outcomes of refractory cardiac arrest patients. METHOD: We retrospectively reviewed 165 consecutive cardiac arrest patients, who underwent E-CPR by VA-ECMO with or without intra-aortic balloon pump (IABP) or ECPELLA from January 2012 to September 2021. We assessed 30-day survival rate, neurological outcome, hemodynamic data, and safety profiles including hemolysis, acute kidney injury, blood transfusion and embolic cerebral infarction. RESULTS: Among 165 E-CPR patients, 35 patients were supported by ECPELLA, and 130 patients were supported by conventional VA-ECMO with or without IABP. Following propensity score matching of 30 ECPELLA and 30 VA-ECMO patients, the 30-day survival (ECPELLA: 53%, VA-ECMO: 20%, p < 0.01) and favorable neurological outcome determined by the Cerebral Performance Category score 1 or 2 (ECPELLA: 33%, VA-ECMO: 7%, p < 0.01) were significantly higher with ECPELLA. Patients receiving ECPELLA also showed significantly higher total mechanical circulatory support flow and lower arterial pulse pressure for the first 3 days (p < 0.01) of treatment. There were no statistical differences in safety profiles between treatment groups. CONCLUSION: ECPELLA may be associated with improved 30-day survival and neurological outcome in patients with refractory cardiac arrest.

Ejemplares similares