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Comparison of Extracorporeal Cardiopulmonary Resuscitation with Conventional Cardiopulmonary Resuscitation: Is Extracorporeal Cardiopulmonary Resuscitation Beneficial?

Lee SH, Jung JS, Lee KH, Kim HJ, Son HS, Sun K - Korean J Thorac Cardiovasc Surg (2015)

Bottom Line: ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis.As the CPR duration increased, the survival discharge and the ROSC rate decreased.Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University School of Medicine.

ABSTRACT

Background: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR).

Methods: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records.

Results: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis.

Conclusion: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

No MeSH data available.


Related in: MedlinePlus

Area underthereceiver operating characteristic curvefor conventional cardiopulmonary resuscitation.
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f3-kjtcv-48-318: Area underthereceiver operating characteristic curvefor conventional cardiopulmonary resuscitation.

Mentions: To determine the cutoff value of the CPR duration for survival discharge, we analyzed the data by using the receiver operating characteristic (ROC) curve. We found that the area under the ROC curve (AUC) in the CCPR group was 0.784. The sensitivity was 72.35 (95% confidence interval [CI], 69.0–75.5), and the specificity was 75.93 (95% CI, 66.7–83.6). The cutoff value of the CPR duration for survival in the CCPR group was 20 minutes (Fig. 3). However, the AUC in the ECPR group was just 0.582. This value was not statistically significant. According to these data, the CPR duration in the ECPR group did not affect the survival rate.


Comparison of Extracorporeal Cardiopulmonary Resuscitation with Conventional Cardiopulmonary Resuscitation: Is Extracorporeal Cardiopulmonary Resuscitation Beneficial?

Lee SH, Jung JS, Lee KH, Kim HJ, Son HS, Sun K - Korean J Thorac Cardiovasc Surg (2015)

Area underthereceiver operating characteristic curvefor conventional cardiopulmonary resuscitation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4622025&req=5

f3-kjtcv-48-318: Area underthereceiver operating characteristic curvefor conventional cardiopulmonary resuscitation.
Mentions: To determine the cutoff value of the CPR duration for survival discharge, we analyzed the data by using the receiver operating characteristic (ROC) curve. We found that the area under the ROC curve (AUC) in the CCPR group was 0.784. The sensitivity was 72.35 (95% confidence interval [CI], 69.0–75.5), and the specificity was 75.93 (95% CI, 66.7–83.6). The cutoff value of the CPR duration for survival in the CCPR group was 20 minutes (Fig. 3). However, the AUC in the ECPR group was just 0.582. This value was not statistically significant. According to these data, the CPR duration in the ECPR group did not affect the survival rate.

Bottom Line: ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis.As the CPR duration increased, the survival discharge and the ROSC rate decreased.Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University School of Medicine.

ABSTRACT

Background: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR).

Methods: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records.

Results: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis.

Conclusion: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

No MeSH data available.


Related in: MedlinePlus