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Predictors of survival following extracorporeal cardiopulmonary resuscitation in patients with acute myocardial infarction-complicated refractory cardiac arrest in the emergency department: a retrospective study.

Han SJ, Kim HS, Choi HH, Hong GS, Lee WK, Lee SH, You DG, Lee JJ - J Cardiothorac Surg (2015)

Bottom Line: Of the patients who survived, 5 of them were able to be discharged.In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177-852.025; p = 0.033).We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. medhan69@hallym.or.kr.

ABSTRACT

Background: This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO).

Methods: We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions.

Results: Mean patient age was 61.4 ± 11.3 years, and 27 patients (73%) were men. Mean CPR time was 50.8 ± 35.4 min. Door-to-ECMO and door-to-balloon times were 84.4 ± 55.3 and 98.4 ± 56.8 min, respectively. Mean ECMO time was 106.4 ± 84.7 h; nine (24%) patients died within 24 h after ECMO initiation. Twelve (32%) patients were weaned off ECMO, seven (19%) of whom survived >30 days after ECMO removal; all except one had Cerebral Performance Category Grade 1. Of the patients who survived, 5 of them were able to be discharged. In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177-852.025; p = 0.033).

Conclusion: We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients.

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Related in: MedlinePlus

Flow diagram of the study population and outcome. ECMO, extracorporeal membrane oxygenation; AMI, acute myocardial infarction; CA, cardiac arrest; ED, emergency department; OHCA, out-of-hospital CA; Cath Lab, catheterization laboratory; ECPR, extracorporeal cardiopulmonary resuscitation.
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Fig1: Flow diagram of the study population and outcome. ECMO, extracorporeal membrane oxygenation; AMI, acute myocardial infarction; CA, cardiac arrest; ED, emergency department; OHCA, out-of-hospital CA; Cath Lab, catheterization laboratory; ECPR, extracorporeal cardiopulmonary resuscitation.

Mentions: ECMO was performed for 124 patients with acute heart failure or acute respiratory failure, for which conventional treatment was ineffective, between January 2006 and August 2012 in the 400-bed Hallym University Chuncheon Sacred Heart Hospital affiliated with Hallym University located in a small town with a population of 300,000. Among the 71 patients who received ECMO on the day of admission to the emergency department (ED), we conducted a retrospective study on 37 patients who received veno-arterial ECMO upon the recurrence of CA within 20 min after the return of spontaneous circulation (ROSC) or due to no signs of ROSC after >10 min of CPR following AMI-induced CA (Figure 1). All patients underwent ECMO during ongoing continuous chest compressions. CPR time was calculated by subtracting ROSC time from the total chest compression time. Patients with unwitnessed cardiac arrest, ongoing intracranial hemorrhage, or terminal cancer were excluded. This study was approved by the institutional review board of Hallym University Chuncheon Sacred Heart Hospital (IRB No. 2012-91).Figure 1


Predictors of survival following extracorporeal cardiopulmonary resuscitation in patients with acute myocardial infarction-complicated refractory cardiac arrest in the emergency department: a retrospective study.

Han SJ, Kim HS, Choi HH, Hong GS, Lee WK, Lee SH, You DG, Lee JJ - J Cardiothorac Surg (2015)

Flow diagram of the study population and outcome. ECMO, extracorporeal membrane oxygenation; AMI, acute myocardial infarction; CA, cardiac arrest; ED, emergency department; OHCA, out-of-hospital CA; Cath Lab, catheterization laboratory; ECPR, extracorporeal cardiopulmonary resuscitation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352552&req=5

Fig1: Flow diagram of the study population and outcome. ECMO, extracorporeal membrane oxygenation; AMI, acute myocardial infarction; CA, cardiac arrest; ED, emergency department; OHCA, out-of-hospital CA; Cath Lab, catheterization laboratory; ECPR, extracorporeal cardiopulmonary resuscitation.
Mentions: ECMO was performed for 124 patients with acute heart failure or acute respiratory failure, for which conventional treatment was ineffective, between January 2006 and August 2012 in the 400-bed Hallym University Chuncheon Sacred Heart Hospital affiliated with Hallym University located in a small town with a population of 300,000. Among the 71 patients who received ECMO on the day of admission to the emergency department (ED), we conducted a retrospective study on 37 patients who received veno-arterial ECMO upon the recurrence of CA within 20 min after the return of spontaneous circulation (ROSC) or due to no signs of ROSC after >10 min of CPR following AMI-induced CA (Figure 1). All patients underwent ECMO during ongoing continuous chest compressions. CPR time was calculated by subtracting ROSC time from the total chest compression time. Patients with unwitnessed cardiac arrest, ongoing intracranial hemorrhage, or terminal cancer were excluded. This study was approved by the institutional review board of Hallym University Chuncheon Sacred Heart Hospital (IRB No. 2012-91).Figure 1

Bottom Line: Of the patients who survived, 5 of them were able to be discharged.In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177-852.025; p = 0.033).We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. medhan69@hallym.or.kr.

ABSTRACT

Background: This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO).

Methods: We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions.

Results: Mean patient age was 61.4 ± 11.3 years, and 27 patients (73%) were men. Mean CPR time was 50.8 ± 35.4 min. Door-to-ECMO and door-to-balloon times were 84.4 ± 55.3 and 98.4 ± 56.8 min, respectively. Mean ECMO time was 106.4 ± 84.7 h; nine (24%) patients died within 24 h after ECMO initiation. Twelve (32%) patients were weaned off ECMO, seven (19%) of whom survived >30 days after ECMO removal; all except one had Cerebral Performance Category Grade 1. Of the patients who survived, 5 of them were able to be discharged. In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177-852.025; p = 0.033).

Conclusion: We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients.

Show MeSH
Related in: MedlinePlus