Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support?

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)637-640
Number of pages4
JournalAmerican Journal of Emergency Medicine
Volume36
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Cardiopulmonary Resuscitation
Heart Arrest
Survival
Patient Discharge
Resuscitation
Survivors

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

@article{9d4327f69c6447bc934733a0fedbaae6,
title = "Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support?",
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.",
author = "Dirk Pabst and Christoph Brehm",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.ajem.2017.09.057",
language = "English (US)",
volume = "36",
pages = "637--640",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "4",

}

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.

UR - http://www.scopus.com/inward/record.url?scp=85030179695&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030179695&partnerID=8YFLogxK

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 -