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.
ANOVA, Analysis of variance
CI, Confidential interval
CPC, Cerebral Performance Categories
CPR, Cardiopulmonary resuscitation
CVP, Central venous pressure
Cardiac arrest
Circulatory support
E-CPR, Extracorporeal cardiopulmonary resuscitation
ECPELLA, Combination of VA-ECMO and Impella transcatheter heart pump support
Extracorporeal cardiopulmonary resuscitation
IABP, Intra-aortic balloon pump
Impella
LV unloading
LV, Left ventricle
MCS, Mechanical circulatory support
Myocardial protection
OHCA, Out-of-hospital cardiac arrest
PAPI, Pulmonary artery pulsatility index
VA-ECMO, Venoarterial extracorporeal membrane oxygenation
VIS, Vasoactive inotrope score
Journal
Resuscitation plus
ISSN: 2666-5204
Titre abrégé: Resusc Plus
Pays: Netherlands
ID NLM: 101774410
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
24
02
2022
revised:
16
04
2022
accepted:
25
04
2022
entrez:
27
5
2022
pubmed:
28
5
2022
medline:
28
5
2022
Statut:
epublish
Résumé
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. 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. 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. ECPELLA may be associated with improved 30-day survival and neurological outcome in patients with refractory cardiac arrest.
Identifiants
pubmed: 35620182
doi: 10.1016/j.resplu.2022.100244
pii: S2666-5204(22)00044-3
pmc: PMC9127400
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100244Informations de copyright
© 2022 The Author(s).
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