Abstract
Background: Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole. Aim: The aim of this study was to investigate the outcome of 3 patient groups separated by initial rhythm at time of ECMO placement during CPR: asystole, PEA and shockable rhythm. Methods: We made a retrospective single-center study of adults who underwent ECPR for in-hospital cardiac arrest between June 2008 and January 2017. Outcome and survival were identified in 3 groups of patients regarding to the heart rhythm at the time decision for ECMO support was made: 1. patients with asystole, 2. patients with pulseless electrical activity, 3. patients with a shockable rhythm. Result: 63 patients underwent ECPR in the mentioned time frame. Five patients were excluded due to incomplete data. Under the 58 included patients the number of cases for asystole, PEA, shockable rhythm was 7, 21 and 30 respectively. The means of CPR-time in these groups were 37, 41 and 37 min. Survival to discharge was 0.0%, 23.8% and 40.0% respectively (p = 0.09). All survivors to discharge had a good neurological outcome, defined as cerebral performance category 1or 2. Conclusion: Survival to discharge in patients with PEA as initial rhythm at the time of decision for ECPR is 23.8% while no patients with asystole as initial rhythm survived discharge. Patients with PEA should be carefully considered for ECPR.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 637-640 |
| Number of pages | 4 |
| Journal | American Journal of Emergency Medicine |
| Volume | 36 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2018 |
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All Science Journal Classification (ASJC) codes
- Emergency Medicine
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Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support? / Pabst, Dirk; Brehm, Christoph.
In: American Journal of Emergency Medicine, Vol. 36, No. 4, 01.04.2018, p. 637-640.Research output: Contribution to journal › Article
TY - JOUR
T1 - Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support?
AU - Pabst, Dirk
AU - Brehm, Christoph
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background: Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole. Aim: The aim of this study was to investigate the outcome of 3 patient groups separated by initial rhythm at time of ECMO placement during CPR: asystole, PEA and shockable rhythm. Methods: We made a retrospective single-center study of adults who underwent ECPR for in-hospital cardiac arrest between June 2008 and January 2017. Outcome and survival were identified in 3 groups of patients regarding to the heart rhythm at the time decision for ECMO support was made: 1. patients with asystole, 2. patients with pulseless electrical activity, 3. patients with a shockable rhythm. Result: 63 patients underwent ECPR in the mentioned time frame. Five patients were excluded due to incomplete data. Under the 58 included patients the number of cases for asystole, PEA, shockable rhythm was 7, 21 and 30 respectively. The means of CPR-time in these groups were 37, 41 and 37 min. Survival to discharge was 0.0%, 23.8% and 40.0% respectively (p = 0.09). All survivors to discharge had a good neurological outcome, defined as cerebral performance category 1or 2. Conclusion: Survival to discharge in patients with PEA as initial rhythm at the time of decision for ECPR is 23.8% while no patients with asystole as initial rhythm survived discharge. Patients with PEA should be carefully considered for ECPR.
AB - Background: Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole. Aim: The aim of this study was to investigate the outcome of 3 patient groups separated by initial rhythm at time of ECMO placement during CPR: asystole, PEA and shockable rhythm. Methods: We made a retrospective single-center study of adults who underwent ECPR for in-hospital cardiac arrest between June 2008 and January 2017. Outcome and survival were identified in 3 groups of patients regarding to the heart rhythm at the time decision for ECMO support was made: 1. patients with asystole, 2. patients with pulseless electrical activity, 3. patients with a shockable rhythm. Result: 63 patients underwent ECPR in the mentioned time frame. Five patients were excluded due to incomplete data. Under the 58 included patients the number of cases for asystole, PEA, shockable rhythm was 7, 21 and 30 respectively. The means of CPR-time in these groups were 37, 41 and 37 min. Survival to discharge was 0.0%, 23.8% and 40.0% respectively (p = 0.09). All survivors to discharge had a good neurological outcome, defined as cerebral performance category 1or 2. Conclusion: Survival to discharge in patients with PEA as initial rhythm at the time of decision for ECPR is 23.8% while no patients with asystole as initial rhythm survived discharge. Patients with PEA should be carefully considered for ECPR.
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U2 - 10.1016/j.ajem.2017.09.057
DO - 10.1016/j.ajem.2017.09.057
M3 - Article
C2 - 28974370
AN - SCOPUS:85030179695
VL - 36
SP - 637
EP - 640
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 4
ER -