ExtraCorporeal life support for Cardiac ARrest in patients with post cardiac arrest syndrome: The ECCAR study.
Adult
Cardiopulmonary Resuscitation
/ adverse effects
Clinical Decision-Making
Extracorporeal Circulation
/ adverse effects
Heart Arrest
/ diagnosis
Humans
Male
Middle Aged
Paris
Recovery of Function
Retrospective Studies
Risk Factors
Shock, Cardiogenic
/ diagnosis
Stroke Volume
Syndrome
Time Factors
Treatment Outcome
Ventricular Function, Left
ECLS
ECMO
Extracorporeal life support
Extracorporeal membrane oxygenation
Post cardiac arrest syndrome
syndrome post arrêt cardiaque
Journal
Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
11
06
2018
revised:
05
08
2018
accepted:
04
11
2018
pubmed:
8
1
2019
medline:
14
6
2019
entrez:
8
1
2019
Statut:
ppublish
Résumé
Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure. To describe our PCAS population, and the factors associated with initiation of ECLS. This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively. The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109μmol/L, respectively) as risk factors for initiation of ECLS. ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.
Sections du résumé
BACKGROUND
BACKGROUND
Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure.
AIM
OBJECTIVE
To describe our PCAS population, and the factors associated with initiation of ECLS.
METHODS
METHODS
This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively.
RESULTS
RESULTS
The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109μmol/L, respectively) as risk factors for initiation of ECLS.
CONCLUSIONS
CONCLUSIONS
ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.
Identifiants
pubmed: 30612896
pii: S1875-2136(18)30199-2
doi: 10.1016/j.acvd.2018.11.005
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
253-260Informations de copyright
Copyright © 2018 Elsevier Masson SAS. All rights reserved.