1887
1 - Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference Proceedings
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of extracorporeal membrane oxygenation (ECMO) – or cardiopulmonary bypass – to provide immediate cardiovascular support for patients who have cardiac arrest unresponsive to conventional cardiopulmonary resuscitation (CPR) measures.

There is improved survival with isolated cardiac lesions.1 Cardiac disease (adjusted for confounding factors) was associated with improved survival when compared with non-cardiac diseases (odds ratio 6.3, 2.01–19.80).2

Conventional CPR versus ECPR has a lower survival to discharge 8.2–22% and about 6–11% for critically ill patients. The survival of out-of-hospital cardiac arrest is less than 3%.3 The long-term survival is 53% with ECPR versus 17% with conventional CPR.4 ECPR in witnessed in-hospital cardiac arrest in areas of advanced life support system and effective CPR with single organ dysfunction with minimum time elapse in logistics like ECPR in cath lab is associated with much better patient outcome and revival to hospital discharge. Procedural support for angioplasty, arrhythmia ablation, pulmonary embolectomy, and bypass surgery are few examples of crash down situations, which are better managed with ECPR. A cath lab is the best place for application of ECMO in a short time. The equipment consists of the ECMO circuit with a centrifugal pump, hollow fiber oxygenator, heat exchanger, back up battery, 3/8 inch venous quick prime tubing, arterial tubing, and percutaneous arterial and venous cannulas. This is a study of 16 cases of ECPR done in a cath lab for witnessed adult cardiac arrests. The decision to initiate ECPR was done in 5 min with circuit priming within 20 min, and simultaneous cannulation performed in 15 min by another team. Overall, 16 patients with cardiac disease over a period of 3 years were included in this study. The age group varied from 35 to 70 years. There were 12 males and 4 females. Six patients had poor left ventricle (LV) with heart failure, who were undergoing bypass surgery. Seven patients had acute myocardial infarction (MI) with cardiac arrest, who were considered for primary angioplasty (PAMI). Two patients had malignant arrhythmias (post-viral) and one patient had pulmonary embolism. There was 8/16 (50%) survival at least 24 h after ECMO decannulation and 5/16 (33%) survival to hospital discharge. Two patients could not be weaned off ECMO support. The most common cause of death was ischemic brain injury. All the survivors had favorable neurological outcome. Two patients had CPR of 60 min prior to ECPR. Pre-arrest factors associated with non-survival were persistent hypotension and renal insufficiency. ECPR promotes survival with ECMO application. Pre-ECMO quality of resuscitation will influence success percentage. Functional outcomes in survivors were reasonable with few derangements, particularly neurological impairments. All procedures were uncomplicated following ECMO application.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2017.swacelso.28
2017-02-14
2020-11-27
Loading full text...

Full text loading...

References

  1. Morris MC, Wernovsky G, Nadkarni VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2004; 5:5:440446.
    [Google Scholar]
  2. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane-Trultt T, for the NRCPR Investigators . Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58:3:297308.
    [Google Scholar]
  3. Chen YS, Chao A, Yu HY, Ko WJ, Wu IH, Chen RJ, Huang SC, Lin FY, Wang SS. Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol. 2003; 41:2:197203.
    [Google Scholar]
  4. Dalton HJ, Siewers RD, Fuhrman BP, Del Nido P, Thompson AE, Shaver MG, Dowhy M. Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction. Crit Care Med. 1993; 21:7:10201028.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2017.swacelso.28
Loading
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error