Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Extracorporeal Cardiopulmonary Resuscitation with Therapeutic Hypothermia for Prolonged Refractory In-hospital Cardiac Arrest

  • Kim, Yun Seok (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lee, Yong Jik (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Won, Ki-Bum (Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Jeong Won (Department of Thoracic and Cardiovascular Surgery, Andong Hospital) ;
  • Lee, Sang Cjeol (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Chang-Ryul (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jung, Jong-Pil (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Choi, Wookjin (Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Received : 2017.04.06
  • Accepted : 2017.08.10
  • Published : 2017.11.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: We identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) followed by therapeutic hypothermia on survival and neurologic outcome in patients with prolonged refractory in-hospital cardiac arrest (IHCA). Methods: We enrolled 16 adult patients who underwent ECPR followed by therapeutic hypothermia between July 2011 and December 2015, for IHCA. Survival at discharge and cerebral performance category (CPC) scale were evaluated. Results: All patients received bystander cardiopulmonary resuscitation (CPR); the mean CPR time was $66.5{\pm}29.9minutes$, and the minimum value was 39 minutes. Eight patients (50%) were discharged alive with favorable neurologic outcomes (CPC 1-2). The mean followup duration was $20.1{\pm}24.3months$, and most deaths occurred within 21 days after ECPR; thereafter, no deaths occurred within one year after the procedure. Conclusion: ECPR followed by therapeutic hypothermia could be considered in prolonged refractory IHCA if bystander-initiated conventional CPR is performed.

Keywords

References

  1. Anselmi A, Flecher E, Corbineau H, et al. Survival and quality of life after extracorporeal life support for refractory cardiac arrest: a case series. J Thorac Cardiovasc Surg 2015;150:947-54. https://doi.org/10.1016/j.jtcvs.2015.05.070
  2. Bednarczyk JM, White CW, Ducas RA, et al. Resuscitative extracorporeal membrane oxygenation for in hospital cardiac arrest: a Canadian observational experience. Resuscitation 2014;85:1713-9. https://doi.org/10.1016/j.resuscitation.2014.09.026
  3. Haneya A, Philipp A, Diez C, et al. A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest. Resuscitation 2012;83:1331-7. https://doi.org/10.1016/j.resuscitation.2012.07.009
  4. Kagawa E, Inoue I, Kawagoe T, et al. Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation 2010;81:968-73. https://doi.org/10.1016/j.resuscitation.2010.03.037
  5. Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008;372:554-61. https://doi.org/10.1016/S0140-6736(08)60958-7
  6. Chen JS, Ko WJ, Yu HY, et al. Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med 2006;34:950-7. https://doi.org/10.1097/01.CCM.0000206103.35460.1F
  7. Massetti M, Tasle M, Le Page O, et al. Back from irreversibility: extracorporeal life support for prolonged cardiac arrest. Ann Thorac Surg 2005;79:178-83. https://doi.org/10.1016/j.athoracsur.2004.06.095
  8. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S444-64. https://doi.org/10.1161/CIR.0000000000000261
  9. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation 2015;86:88-94. https://doi.org/10.1016/j.resuscitation.2014.09.010
  10. Ryu JA, Cho YH, Sung K, et al. Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation. BMC Anesthesiol 2015;15:26. https://doi.org/10.1186/s12871-015-0002-3
  11. Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study. Crit Care 2014;18:535. https://doi.org/10.1186/s13054-014-0535-8
  12. Patel JK, Schoenfeld E, Parnia S, Singer AJ, Edelman N. Venoarterial extracorporeal membrane oxygenation in adults with cardiac arrest. J Intensive Care Med 2016;31:359-68. https://doi.org/10.1177/0885066615583651
  13. Ortega-Deballon I, Hornby L, Shemie SD, Bhanji F, Guadagno E. Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: a systematic review of international practices and outcomes. Resuscitation 2016;101:12-20. https://doi.org/10.1016/j.resuscitation.2016.01.018
  14. Siao FY, Chiu CC, Chiu CW, et al. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation. Resuscitation 2015;92:70-6. https://doi.org/10.1016/j.resuscitation.2015.04.016
  15. Badjatia N, Strongilis E, Gordon E, et al. Metabolic impact of shivering during therapeutic temperature modulation: the Bedside Shivering Assessment Scale. Stroke 2008;39:3242-7. https://doi.org/10.1161/STROKEAHA.108.523654
  16. Wang CH, Huang CH, Chang WT, et al. Associations among gender, marital status, and outcomes of adult in-hospital cardiac arrest: a retrospective cohort study. Resuscitation 2016;107:1-6. https://doi.org/10.1016/j.resuscitation.2016.07.005
  17. Kim DH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Extracorporeal cardiopulmonary resuscitation: predictors of survival. Korean J Thorac Cardiovasc Surg 2016;49:273-9. https://doi.org/10.5090/kjtcs.2016.49.4.273
  18. Sakamoto S, Taniguchi N, Nakajima S, Takahashi A. Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome. Ann Thorac Surg 2012;94:1-7. https://doi.org/10.1016/j.athoracsur.2012.01.032
  19. Pang PY, Wee GH, Hoo AE, et al. Therapeutic hypothermia in adult patients receiving extracorporeal life support: early results of a randomized controlled study. J Cardiothorac Surg 2016;11:43. https://doi.org/10.1186/s13019-016-0437-8
  20. Rittenberger JC, Friess S, Polderman KH. Emergency neurological life support: resuscitation following cardiac arrest. Neurocrit Care 2015;23 Suppl 2:S119-28. https://doi.org/10.1007/s12028-015-0171-4

Cited by

  1. Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis vol.28, pp.1, 2020, https://doi.org/10.1186/s13049-019-0698-z
  2. Impact of therapeutic hypothermia on bleeding events in adult patients treated with extracorporeal life support peri-cardiac arrest vol.62, pp.None, 2017, https://doi.org/10.1016/j.jcrc.2020.11.008