Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study.
Cardiac arrest
Cardiopulmonary resuscitation
Extracorporeal circulation
Extracorporeal membrane oxygenation out-of-hospital cardiac arrest
In-hospital cardiac arrest
Prognosis
Journal
BMC emergency medicine
ISSN: 1471-227X
Titre abrégé: BMC Emerg Med
Pays: England
ID NLM: 100968543
Informations de publication
Date de publication:
05 Mar 2024
05 Mar 2024
Historique:
received:
23
07
2023
accepted:
06
11
2023
medline:
5
3
2024
pubmed:
5
3
2024
entrez:
4
3
2024
Statut:
epublish
Résumé
The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.
Sections du résumé
BACKGROUND
BACKGROUND
The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO).
METHODS
METHODS
This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA.
RESULTS
RESULTS
The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest.
CONCLUSIONS
CONCLUSIONS
Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.
Identifiants
pubmed: 38438853
doi: 10.1186/s12873-023-00905-8
pii: 10.1186/s12873-023-00905-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
36Informations de copyright
© 2024. The Author(s).
Références
Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: a review. JAMA. 2019;321(12):1200–10. https://doi.org/10.1001/jama.2019.1696 .
doi: 10.1001/jama.2019.1696
pubmed: 30912843
pmcid: 6482460
Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital Cardiac Arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–87. https://doi.org/10.1016/j.resuscitation.2010.08.006 .
doi: 10.1016/j.resuscitation.2010.08.006
pubmed: 20828914
Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, et al. The global survival rate among adult out-of-hospital Cardiac Arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24(1):61. https://doi.org/10.1186/s13054-020-2773-2 .
doi: 10.1186/s13054-020-2773-2
pubmed: 32087741
pmcid: 7036236
Zanders R, Druwé P, Van Den Noortgate N, Piers R. The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review. Eur Geriatr Med. 2021;12(4):695–723. https://doi.org/10.1007/s41999-021-00454-y .
doi: 10.1007/s41999-021-00454-y
pubmed: 33683679
pmcid: 7938035
Vestergaard LD, Lauridsen KG, Krarup NHV, Kristensen JU, Andersen LK, Løfgren B. Quality of cardiopulmonary resuscitation and 5-Year survival following in-hospital Cardiac Arrest. Open Access Emergency Medicine: OAEM. 2021;13:553–60. https://doi.org/10.2147/oaem.s341479 .
doi: 10.2147/oaem.s341479
pubmed: 34938129
pmcid: 8687881
Singer JL, Mosesso VN Jr. After the lights and sirens: patient access delay in Cardiac Arrest. Resuscitation. 2020;155:234–5. https://doi.org/10.1016/j.resuscitation.2020.07.027 .
doi: 10.1016/j.resuscitation.2020.07.027
pubmed: 32810559
pmcid: 7428674
Bircher NG, Chan PS, Xu Y, Association AH. Delays in cardiopulmonary resuscitation, defibrillation, and epinephrine administration all decrease survival in in-hospital Cardiac Arrest. Anesthesiology. 2019;130(3):414–22.
doi: 10.1097/ALN.0000000000002563
pubmed: 30707123
Balan P, Hsi B, Thangam M, Zhao Y, Monlezun D, Arain S, et al. The Cardiac Arrest survival score: a predictive algorithm for in-hospital mortality after out-of-hospital Cardiac Arrest. Resuscitation. 2019;144:46–53.
doi: 10.1016/j.resuscitation.2019.09.009
pubmed: 31539610
McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, et al. Out-of-hospital Cardiac Arrest surveillance—Cardiac Arrest registry to enhance survival (CARES), United States, October 1, 2005–December 31, 2010. Morbidity and Mortality Weekly Report. Surveillance Summaries. 2011;60(8):1–19.
pubmed: 21796098
Hsia RY, Huang D, Mann NC, Colwell C, Mercer MP, Dai M, et al. A US national study of the association between income and ambulance response time in Cardiac Arrest. JAMA Netw Open. 2018;1(7):e185202–2.
doi: 10.1001/jamanetworkopen.2018.5202
pubmed: 30646394
pmcid: 6324393
Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital Cardiac Arrest: a graphic model. Ann Emerg Med. 1993;22(11):1652–8.
doi: 10.1016/S0196-0644(05)81302-2
pubmed: 8214853
Richardson ASC, Tonna JE, Nanjayya V, Nixon P, Abrams DC, Raman L, et al. Extracorporeal cardiopulmonary resuscitation in adults. Interim Guideline Consensus Statement from the extracorporeal life support Organization. ASAIO J (American Soc Artif Intern Organs: 1992). 2021;67(3):221–8. https://doi.org/10.1097/mat.0000000000001344 .
doi: 10.1097/mat.0000000000001344
Jacobs I, Nadkarni V, Participants C, Bahr J, Outcomes CR. Cardiac Arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation councils of Southern Africa). Circulation. 2004;110(21):3385–97.
doi: 10.1161/01.CIR.0000147236.85306.15
pubmed: 15557386
Kumar KM. ECPR-extracorporeal cardiopulmonary resuscitation. Indian J Thorac Cardiovasc Surg. 2021;37(Suppl 2):294–302. https://doi.org/10.1007/s12055-020-01072-2 .
doi: 10.1007/s12055-020-01072-2
pubmed: 33432257
pmcid: 7787697
Schiff T, Koziatek C, Pomerantz E, Bosson N, Montgomery R, Parent B, et al. Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations. Crit Care. 2023;27(1):144. https://doi.org/10.1186/s13054-023-04432-7 .
doi: 10.1186/s13054-023-04432-7
pubmed: 37072806
pmcid: 10111746
Goto Y, Funada A, Goto Y. Relationship between the duration of cardiopulmonary resuscitation and favorable neurological outcomes after out-of-hospital Cardiac Arrest: a prospective, Nationwide, Population-based Cohort Study. J Am Heart Association. 2016;5(3):e002819. https://doi.org/10.1161/jaha.115.002819 .
doi: 10.1161/jaha.115.002819
Duan J, Zhai Q, Shi Y, Ge H, Zheng K, Du L, et al. Optimal time of collapse to return of spontaneous circulation to apply targeted temperature management for Cardiac Arrest: a bayesian network Meta-analysis. Front Cardiovasc Med. 2021;8:784917. https://doi.org/10.3389/fcvm.2021.784917 .
doi: 10.3389/fcvm.2021.784917
pubmed: 35071355
Ryu J-A, Chung CR, Cho YH, Sung K, Jeon K, Suh GY, et al. Neurologic outcomes in patients who undergo extracorporeal cardiopulmonary resuscitation. Ann Thorac Surg. 2019;108(3):749–55.
doi: 10.1016/j.athoracsur.2019.03.033
pubmed: 30981847
Hutin A, Abu-Habsa M, Burns B, Bernard S, Bellezzo J, Shinar Z, et al. Early ECPR for out-of-hospital Cardiac Arrest: best practice in 2018. Resuscitation. 2018;130:44–8.
doi: 10.1016/j.resuscitation.2018.05.004
pubmed: 29738799
Elmelliti H, Vahedian-Azimi A, Albazoon F, Alqahwachi H, Akbar A, Shehatta AL et al. Outcomes of patients with in- and out-of-hospital Cardiac Arrest on extracorporeal cardiopulmonary resuscitation: a single-center Retrospective Cohort Study. Current problems in cardiology. 2023, 48(5):101578. https://doi.org/10.1016/j.cpcardiol.2022.101578 .
Murakami N, Kokubu N, Nagano N, Nishida J, Nishikawa R, Nakata J, et al. Prognostic impact of No-Flow Time on 30-Day neurological outcomes in patients with out-of-hospital Cardiac Arrest who received extracorporeal cardiopulmonary resuscitation. Circ J. 2020;84(7):1097–104. https://doi.org/10.1253/circj.CJ-19-1177 .
doi: 10.1253/circj.CJ-19-1177
pubmed: 32522902
Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory Cardiac Arrest. A systematic review and meta-analysis. Resuscitation. 2017;112:1–10.
doi: 10.1016/j.resuscitation.2016.12.011
pubmed: 28007504
Adnet F, Triba MN, Borron SW, Lapostolle F, Hubert H, Gueugniaud P-Y, et al. Cardiopulmonary resuscitation duration and survival in out-of-hospital Cardiac Arrest patients. Resuscitation. 2017;111:74–81.
doi: 10.1016/j.resuscitation.2016.11.024
pubmed: 27987396
Xu F, Zhang Y, Chen Y. Cardiopulmonary resuscitation training in China: current Situation and Future Development. JAMA Cardiol. 2017;2(5):469–70. https://doi.org/10.1001/jamacardio.2017.0035 .
doi: 10.1001/jamacardio.2017.0035
pubmed: 28297007
Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, et al. Bystander efforts and 1-Year outcomes in out-of-hospital Cardiac Arrest. N Engl J Med. 2017;376(18):1737–47. https://doi.org/10.1056/NEJMoa1601891 .
doi: 10.1056/NEJMoa1601891
pubmed: 28467879
World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014;81(3):14–8.
Cuschieri S, Saudi JA. 2019, 13(Suppl 1):S31–s34. https://doi.org/10.4103/sja.SJA_543_18 .
Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al. Part 1: executive summary: 2020 American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16suppl2):337–S357. https://doi.org/10.1161/CIR.0000000000000918 .
doi: 10.1161/CIR.0000000000000918
Ryu JA, Chung CR, Cho YH, Sung K, Suh GY, Park TK et al. The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation. Crit Care 2017, 21(1):15. https://doi.org/10.1186/s13054-017-1604-6 .
Ryu J-A, Cho YH, Sung K, Choi SH, Yang JH, Choi J-H, et al. Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation. BMC Anesthesiol. 2015;15(1):26. https://doi.org/10.1186/s12871-015-0002-3 .
doi: 10.1186/s12871-015-0002-3
pubmed: 25774089
pmcid: 4358703
Salluh JI, Soares M. ICU severity of Illness scores: APACHE, SAPS and MPM. Curr Opin Crit Care. 2014;20(5):557–65. https://doi.org/10.1097/mcc.0000000000000135 .
doi: 10.1097/mcc.0000000000000135
pubmed: 25137401
Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019;23(1):374. https://doi.org/10.1186/s13054-019-2663-7 .
doi: 10.1186/s13054-019-2663-7
pubmed: 31775846
pmcid: 6880479
Woolcott OO, Reinier K, Uy-Evanado A, Nichols GA, Stecker EC, Jui J, et al. Sudden Cardiac Arrest with shockable rhythm in patients with Heart Failure. Heart Rhythm. 2020;17(10):1672–8. https://doi.org/10.1016/j.hrthm.2020.05.038 .
doi: 10.1016/j.hrthm.2020.05.038
pubmed: 32504821
pmcid: 7541513
Li Y, Bisera J, Geheb F, Tang W, Weil MH. Identifying potentially shockable rhythms without interrupting cardiopulmonary resuscitation. Crit Care Med. 2008;36(1):198–203. https://doi.org/10.1097/01.Ccm.0000295589.64729.6b .
doi: 10.1097/01.Ccm.0000295589.64729.6b
pubmed: 18090359
Guy A, Kawano T, Besserer F, Scheuermeyer F, Kanji HD, Christenson J et al. The relationship between no-flow interval and survival with favourable neurological outcome in out-of-hospital Cardiac Arrest: implications for outcomes and ECPR eligibility. Resusc 2020, 155:219–25. https://doi.org/10.1016/j.resuscitation.2020.06.009 .
Wengenmayer T, Rombach S, Ramshorn F, Biever P, Bode C, Duerschmied D, et al. Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care. 2017;21(1):157. https://doi.org/10.1186/s13054-017-1744-8 .
doi: 10.1186/s13054-017-1744-8
pubmed: 28637497
pmcid: 5480193
Runde D. Calculated decisions: Modified Rankin Scale (mRS) for neurologic disability. Emerg Med Pract. 2019;21(Suppl 6):Cd4–cd5.
pubmed: 31294946
Grossestreuer AV, Abella BS, Sheak KR, Cinousis MJ, Perman SM, Leary M, et al. Inter-rater reliability of post-arrest cerebral performance category (CPC) scores. Resuscitation. 2016;109:21–4. https://doi.org/10.1016/j.resuscitation.2016.09.006 .
doi: 10.1016/j.resuscitation.2016.09.006
pubmed: 27650863
pmcid: 5990009
Fuchs A, Käser D, Theiler L, Greif R, Knapp J, Berger-Estilita J. Survival and long-term outcomes following in-hospital Cardiac Arrest in a Swiss university hospital: a prospective observational study. Scand J Trauma Resusc Emerg Med. 2021;29(1):115. https://doi.org/10.1186/s13049-021-00931-0 .
doi: 10.1186/s13049-021-00931-0
pubmed: 34380539
pmcid: 8359113
Higashi A, Nakada TA, Imaeda T, Abe R, Shinozaki K, Oda S. Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital Cardiac Arrest. J Intensive Care. 2020;8:39. https://doi.org/10.1186/s40560-020-00457-0 .
doi: 10.1186/s40560-020-00457-0
pubmed: 32549988
pmcid: 7294673
Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital Cardiac Arrest. N Engl J Med. 2015;372(24):2307–15. https://doi.org/10.1056/NEJMoa1405796 .
doi: 10.1056/NEJMoa1405796
pubmed: 26061835
Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital Cardiac Arrest: when should we change to novel therapies? Circulation. 2013, 128(23):2488–94. https://doi.org/10.1161/circulationaha.113.002408 .
Welbourn C, Efstathiou N. How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving Cardiac Arrest? A systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):77. https://doi.org/10.1186/s13049-018-0476-3 .
doi: 10.1186/s13049-018-0476-3
pubmed: 30201018
pmcid: 6131783
Lee MJ, Ryu JH, Min MK, Lee DS, Yeom SR, Bae B-K et al., : Predictors of survival and good neurological outcomes after in-hospital cardiac arrest. In: 2021; 2021
Wang C-H, Chou N-K, Becker LB, Lin J-W, Yu H-Y, Chi N-H et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital Cardiac Arrest – a comparison with that for extracorporeal rescue for in-hospital Cardiac Arrest. Resusc 2014, 85(9):1219–24. https://doi.org/10.1016/j.resuscitation.2014.06.022 .
Adnet F, Triba MN, Borron SW, Lapostolle F, Hubert H, Gueugniaud PY, et al. Cardiopulmonary resuscitation duration and survival in out-of-hospital Cardiac Arrest patients. Resuscitation. 2017;111:74–81. https://doi.org/10.1016/j.resuscitation.2016.11.024 .
doi: 10.1016/j.resuscitation.2016.11.024
pubmed: 27987396
Martinell L, Nielsen N, Herlitz J, Karlsson T, Horn J, Wise MP, et al. Early predictors of poor outcome after out-of-hospital Cardiac Arrest. Crit Care. 2017;21(1):96. https://doi.org/10.1186/s13054-017-1677-2 .
doi: 10.1186/s13054-017-1677-2
pubmed: 28410590
pmcid: 5391587
Twohig CJ, Singer B, Grier G, Finney SJ. A systematic literature review and meta-analysis of the effectiveness of extracorporeal-CPR versus conventional-CPR for adult patients in Cardiac Arrest. J Intensive Care Soc. 2019;20(4):347–57. https://doi.org/10.1177/1751143719832162 .
doi: 10.1177/1751143719832162
pubmed: 31695740
pmcid: 6820228
Park S, Lee SW, Han KS, Lee EJ, Jang D-H, Lee SJ, et al. Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital Cardiac Arrest. Scand J Trauma Resusc Emerg Med. 2022;30(1):5. https://doi.org/10.1186/s13049-022-00993-8 .
doi: 10.1186/s13049-022-00993-8
pubmed: 35033185
pmcid: 8760684