The Need to Develop Standardized Protocols for the Timing of Extracorporeal Membrane Oxygenation Initiation Among Adult Patients in Cardiac Arrest: A Case Study

Overview

Journal J Extra Corpor Technol

Publisher EDP Sciences

Specialties Biotechnology
General Surgery
Health Services

Date 2015 Sep 12

PMID 26357800

Citations 2

Authors

Matthew Mosca

Allison Weinberg

Affiliations

Soon will be listed here.

Abstract

The duration of time between cardiac arrest, cardiopulmonary resuscitation (CPR), and initiation of extracorporeal membrane oxygenation (ECMO) among refractory patients is correlated with mortality. The duration of conventional CPR (CCPR) beyond which ECMO support should not be offered due to poor outcomes is not established. This case study describes a patient with heart failure with recurrent episodes of ventricular tachycardia who had a witnessed cardiac arrest in a coronary care unit. The patient received approximately 45 minutes of CCPR. Venoarterial ECMO was then initiated for extracorporeal CPR (ECPR) support. The total recorded ischemic time between CCPR and ECPR was 60 minutes. Despite aggressive medical therapy, ECMO support was discontinued 48 hours later following absence of electroencephalographic activity and no evidence of cardiac function ultimately leading to the patient's death. This case study illustrates the possibility that prolonged ischemia resulting from duration of CCPR and time to initiate ECPR may contribute to adverse clinical outcomes. Systems of care that might reduce delays in ECMO initiation and improve patient outcomes are discussed including: 1) development of standardized protocols to allow for rapid initiation of ECMO support; 2) systematic evaluation of parameters such as biomarkers that might identify patients at risk for cardiac arrest in settings where ECMO is readily available; and 3) assessment of patient criteria to define subsets of individuals among whom late institution of ECMO, an expensive and labor-intensive mode of circulatory support, might be futile.

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References

Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A . The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011; 37(9):1447-57. PMC: 7080128. DOI: 10.1007/s00134-011-2301-6. View

Cheliout-Heraut F, Rubinsztajn R, Ioos C, Estournet B . Prognostic value of evoked potentials and sleep recordings in the prolonged comatose state of children. Preliminary data. Neurophysiol Clin. 2002; 31(5):283-92. DOI: 10.1016/s0987-7053(01)00270-2. View

Chiu C, Yen H, Chiu C, Chen Y, Siao F . Prolonged cardiac arrest: successful resuscitation with extracorporeal membrane oxygenation. Am J Emerg Med. 2013; 31(11):1627.e5-6. DOI: 10.1016/j.ajem.2013.06.040. View

Nadkarni V, Larkin G, Peberdy M, Carey S, Kaye W, Mancini M . First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006; 295(1):50-7. DOI: 10.1001/jama.295.1.50. View

Levine R, Wayne M, Miller C . End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med. 1997; 337(5):301-6. DOI: 10.1056/NEJM199707313370503. View

Bottiger B, Mobes S, Glatzer R, Bauer H, Gries A, Bartsch P . Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Circulation. 2001; 103(22):2694-8. DOI: 10.1161/01.cir.103.22.2694. View

Hajbaghery M, Mousavi G, Akbari H . Factors influencing survival after in-hospital cardiopulmonary resuscitation. Resuscitation. 2005; 66(3):317-21. DOI: 10.1016/j.resuscitation.2005.04.004. View

Bistrussu S, Beeton A, Castaldo G, Han J, Wong I, Tuleu C . Are extracorporeal membrane oxygenation circuits that are primed with plasmalyte and stored a likely source of infection?. J Clin Microbiol. 2004; 42(8):3906. PMC: 497623. DOI: 10.1128/JCM.42.8.3906.2004. View

SCHULTZ S, Cullinane D, Pasquale M, MAGNANT C, Evans S . Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation. 1996; 33(1):13-7. DOI: 10.1016/s0300-9572(96)00986-0. View

10.

Huang S, Wu E, Chen Y, Chang C, Chiu I, Wang S . Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med. 2008; 36(5):1607-13. DOI: 10.1097/CCM.0b013e318170b82b. View

11.

Karimova A, Robertson A, Cross N, Smith L, OCallaghan M, Tuleu C . A wet-primed extracorporeal membrane oxygenation circuit with hollow-fiber membrane oxygenator maintains adequate function for use during cardiopulmonary resuscitation after 2 weeks on standby. Crit Care Med. 2005; 33(7):1572-6. DOI: 10.1097/01.ccm.0000168598.40541.22. View

12.

Chai P, Jacobs J, Dalton H, Costello J, Cooper D, Kirsch R . Extracorporeal cardiopulmonary resuscitation for post-operative cardiac arrest: indications, techniques, controversies, and early results--what is known (and unknown). Cardiol Young. 2011; 21 Suppl 2:109-17. DOI: 10.1017/S1047951111001685. View

13.

Mewasingh L, Christophe C, Fonteyne C, Dachy B, Ziereisen F, Christiaens F . Predictive value of electrophysiology in children with hypoxic coma. Pediatr Neurol. 2003; 28(3):178-83. DOI: 10.1016/s0887-8994(02)00509-x. View

14.

. Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health. Ann Fr Anesth Reanim. 2009; 28(2):182-90. DOI: 10.1016/j.annfar.2008.12.011. View

15.

. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005; 112(24 Suppl):IV1-203. DOI: 10.1161/CIRCULATIONAHA.105.166550. View

16.

Andreka P, Frenneaux M . Haemodynamics of cardiac arrest and resuscitation. Curr Opin Crit Care. 2006; 12(3):198-203. DOI: 10.1097/01.ccx.0000224861.70958.59. View

17.

Kelly R, Harrison R . Outcome predictors of pediatric extracorporeal cardiopulmonary resuscitation. Pediatr Cardiol. 2010; 31(5):626-33. PMC: 2886903. DOI: 10.1007/s00246-010-9659-z. View

18.

Kane D, Thiagarajan R, Wypij D, Scheurer M, Fynn-Thompson F, Emani S . Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation. 2010; 122(11 Suppl):S241-8. DOI: 10.1161/CIRCULATIONAHA.109.928390. View

19.

Peberdy M, Kaye W, Ornato J, Larkin G, Nadkarni V, Mancini M . Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58(3):297-308. DOI: 10.1016/s0300-9572(03)00215-6. View

20.

Chen Y, Yu H, Huang S, Lin J, Chi N, Wang C . Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation. Crit Care Med. 2008; 36(9):2529-35. DOI: 10.1097/CCM.0b013e318183f491. View