Prognostic factors and mortality predictive scale in patients treated with in-hospital extracorporeal cardiopulmonary resuscitation
Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, evidence is limited and randomized studies are lacking regarding in-hospital CA. Purpose Our objective was the iden...
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| Veröffentlicht in: | European heart journal 2023-11, Vol.44 (Supplement_2) |
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| creator | Alonso Fernandez De Gatta, M Hernandez Martos, A V Diego Nieto, A Merchan Gomez, S Martin Herrero, F Gonzalez Cebrian, M Toranzo Nieto, I Barrio Rodriguez, A Cid Menendez, A Gonzalez Calle, D Sanchez, P L |
| description | Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, evidence is limited and randomized studies are lacking regarding in-hospital CA.
Purpose
Our objective was the identification of factors associated with survival in in-hospital ECPR.
Methods
Retrospective analysis of consecutive cases of venoarterial extracorporeal membrane oxygenator (VA-ECMO) for ECPR indication in a referral center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analyzed baseline variables related to CA and ECPR technique and studied their relationship with in-hospital survival.
Results
Out of 207 VA-ECMO implants between 2014-feb 2023, we selected the ECPR cases: N=59 (28.5%). Baseline, admission and ECPR characteristics are collected in the table.
ECMO-VA support intention was bridge to recovery in 68% of cases, transplant 5%, ventricular assist device 5% and decision 22%. The most frequent access was percutaneous femoro-femoral, and ECPR was unsuccessful (no flow, no rhythm, or impossibility of cannulation in 11.8% of cases). All patients underwent temperature control at 36ºC with ECMO.
Overall in-hospital survival was 18.6% (n=11) (cerebral performance cathegory 1-2), and the most frequent causes of death were refractory shock/multiple organ failure (49%) and anoxic encephalopathy (25%).
The patients who died were significantly younger, had peripheral vascular disease (PAD), higher creatinine, LDH and lactate levels, longer CA duration, and its ECMO implantation was more frequent during on-call hours (table). Lactate >10.05 predicted mortality (AUC 0.693, Sens 67,3%, Esp 80%). The time under VA-ECMO support and mechanical ventilation, and the use of adrenaline infusion were more frequent in the survivors (table).
At multivariate analysis, a longer CA duration (HR 0.947, CI95% 0.900-0.977, p0,040) was the only factor independently associated with in-hospital mortality.
We developed a predictive scale including factors related to survival (lactate >10.05, >60 minutes CA, PAD, on-call time) which predicted 100% with 3 or more factors (p |
| doi_str_mv | 10.1093/eurheartj/ehad655.1570 |
| format | Article |
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Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, evidence is limited and randomized studies are lacking regarding in-hospital CA.
Purpose
Our objective was the identification of factors associated with survival in in-hospital ECPR.
Methods
Retrospective analysis of consecutive cases of venoarterial extracorporeal membrane oxygenator (VA-ECMO) for ECPR indication in a referral center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analyzed baseline variables related to CA and ECPR technique and studied their relationship with in-hospital survival.
Results
Out of 207 VA-ECMO implants between 2014-feb 2023, we selected the ECPR cases: N=59 (28.5%). Baseline, admission and ECPR characteristics are collected in the table.
ECMO-VA support intention was bridge to recovery in 68% of cases, transplant 5%, ventricular assist device 5% and decision 22%. The most frequent access was percutaneous femoro-femoral, and ECPR was unsuccessful (no flow, no rhythm, or impossibility of cannulation in 11.8% of cases). All patients underwent temperature control at 36ºC with ECMO.
Overall in-hospital survival was 18.6% (n=11) (cerebral performance cathegory 1-2), and the most frequent causes of death were refractory shock/multiple organ failure (49%) and anoxic encephalopathy (25%).
The patients who died were significantly younger, had peripheral vascular disease (PAD), higher creatinine, LDH and lactate levels, longer CA duration, and its ECMO implantation was more frequent during on-call hours (table). Lactate >10.05 predicted mortality (AUC 0.693, Sens 67,3%, Esp 80%). The time under VA-ECMO support and mechanical ventilation, and the use of adrenaline infusion were more frequent in the survivors (table).
At multivariate analysis, a longer CA duration (HR 0.947, CI95% 0.900-0.977, p0,040) was the only factor independently associated with in-hospital mortality.
We developed a predictive scale including factors related to survival (lactate >10.05, >60 minutes CA, PAD, on-call time) which predicted 100% with 3 or more factors (p<0.001) (figure 2).
Conclusions
In-hospital ECPR is an option for refractory cardiac arrest, with high mortality. CA duration was the only factor independently associated with in-hospital mortality. Three or more adverse factors (lactate >10.05, >60 minutes CA, PAD, on-call time) predicted 100% mortality. Randomized studies are needed to determine a better selection of patientsBaseline, admission and ECPRMortality predictive scale after ECPR</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehad655.1570</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2023-11, Vol.44 (Supplement_2)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids></links><search><creatorcontrib>Alonso Fernandez De Gatta, M</creatorcontrib><creatorcontrib>Hernandez Martos, A V</creatorcontrib><creatorcontrib>Diego Nieto, A</creatorcontrib><creatorcontrib>Merchan Gomez, S</creatorcontrib><creatorcontrib>Martin Herrero, F</creatorcontrib><creatorcontrib>Gonzalez Cebrian, M</creatorcontrib><creatorcontrib>Toranzo Nieto, I</creatorcontrib><creatorcontrib>Barrio Rodriguez, A</creatorcontrib><creatorcontrib>Cid Menendez, A</creatorcontrib><creatorcontrib>Gonzalez Calle, D</creatorcontrib><creatorcontrib>Sanchez, P L</creatorcontrib><title>Prognostic factors and mortality predictive scale in patients treated with in-hospital extracorporeal cardiopulmonary resuscitation</title><title>European heart journal</title><description>Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, evidence is limited and randomized studies are lacking regarding in-hospital CA.
Purpose
Our objective was the identification of factors associated with survival in in-hospital ECPR.
Methods
Retrospective analysis of consecutive cases of venoarterial extracorporeal membrane oxygenator (VA-ECMO) for ECPR indication in a referral center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analyzed baseline variables related to CA and ECPR technique and studied their relationship with in-hospital survival.
Results
Out of 207 VA-ECMO implants between 2014-feb 2023, we selected the ECPR cases: N=59 (28.5%). Baseline, admission and ECPR characteristics are collected in the table.
ECMO-VA support intention was bridge to recovery in 68% of cases, transplant 5%, ventricular assist device 5% and decision 22%. The most frequent access was percutaneous femoro-femoral, and ECPR was unsuccessful (no flow, no rhythm, or impossibility of cannulation in 11.8% of cases). All patients underwent temperature control at 36ºC with ECMO.
Overall in-hospital survival was 18.6% (n=11) (cerebral performance cathegory 1-2), and the most frequent causes of death were refractory shock/multiple organ failure (49%) and anoxic encephalopathy (25%).
The patients who died were significantly younger, had peripheral vascular disease (PAD), higher creatinine, LDH and lactate levels, longer CA duration, and its ECMO implantation was more frequent during on-call hours (table). Lactate >10.05 predicted mortality (AUC 0.693, Sens 67,3%, Esp 80%). The time under VA-ECMO support and mechanical ventilation, and the use of adrenaline infusion were more frequent in the survivors (table).
At multivariate analysis, a longer CA duration (HR 0.947, CI95% 0.900-0.977, p0,040) was the only factor independently associated with in-hospital mortality.
We developed a predictive scale including factors related to survival (lactate >10.05, >60 minutes CA, PAD, on-call time) which predicted 100% with 3 or more factors (p<0.001) (figure 2).
Conclusions
In-hospital ECPR is an option for refractory cardiac arrest, with high mortality. CA duration was the only factor independently associated with in-hospital mortality. Three or more adverse factors (lactate >10.05, >60 minutes CA, PAD, on-call time) predicted 100% mortality. Randomized studies are needed to determine a better selection of patientsBaseline, admission and ECPRMortality predictive scale after ECPR</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqNkE1LAzEQQIMoWKt_QfIHtk26zddRil9Q0IOCtyWbTN2U7WaZZNWe_eOutHj2NId5bxgeIdeczTgz5RwGbMBi3s6hsV4KMeNCsRMy4WKxKIxcilMyYdyIQkr9dk4uUtoyxrTkckK-nzG-dzHl4OjGuhwxUdt5uouYbRvynvYIPrgcPoAmZ1ugoaO9zQG6nGhGsBk8_Qy5GRdFE1MfRpHCV0brIvZxJFrqLPoQ-6Hdxc7iniKkIbmRzCF2l-RsY9sEV8c5Ja93ty-rh2L9dP-4ulkXjpeKFdJrZ7lRRtjS17UWpVAcdL0sa6V5rZ3yXJYLrbjTxi21VQDS1UZo4Q2M-JTIw12HMSWETdVj2I3vVJxVvymrv5TVMWX1m3IU-UGMQ_9f5wc2IIGY</recordid><startdate>20231109</startdate><enddate>20231109</enddate><creator>Alonso Fernandez De Gatta, M</creator><creator>Hernandez Martos, A V</creator><creator>Diego Nieto, A</creator><creator>Merchan Gomez, S</creator><creator>Martin Herrero, F</creator><creator>Gonzalez Cebrian, M</creator><creator>Toranzo Nieto, I</creator><creator>Barrio Rodriguez, A</creator><creator>Cid Menendez, A</creator><creator>Gonzalez Calle, D</creator><creator>Sanchez, P L</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20231109</creationdate><title>Prognostic factors and mortality predictive scale in patients treated with in-hospital extracorporeal cardiopulmonary resuscitation</title><author>Alonso Fernandez De Gatta, M ; Hernandez Martos, A V ; Diego Nieto, A ; Merchan Gomez, S ; Martin Herrero, F ; Gonzalez Cebrian, M ; Toranzo Nieto, I ; Barrio Rodriguez, A ; Cid Menendez, A ; Gonzalez Calle, D ; Sanchez, P L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1370-6d8ca19795a3dbb853571e8b43b781b8c7d1632871c89c48a7ee6cb9585d9e853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alonso Fernandez De Gatta, M</creatorcontrib><creatorcontrib>Hernandez Martos, A V</creatorcontrib><creatorcontrib>Diego Nieto, A</creatorcontrib><creatorcontrib>Merchan Gomez, S</creatorcontrib><creatorcontrib>Martin Herrero, F</creatorcontrib><creatorcontrib>Gonzalez Cebrian, M</creatorcontrib><creatorcontrib>Toranzo Nieto, I</creatorcontrib><creatorcontrib>Barrio Rodriguez, A</creatorcontrib><creatorcontrib>Cid Menendez, A</creatorcontrib><creatorcontrib>Gonzalez Calle, D</creatorcontrib><creatorcontrib>Sanchez, P L</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alonso Fernandez De Gatta, M</au><au>Hernandez Martos, A V</au><au>Diego Nieto, A</au><au>Merchan Gomez, S</au><au>Martin Herrero, F</au><au>Gonzalez Cebrian, M</au><au>Toranzo Nieto, I</au><au>Barrio Rodriguez, A</au><au>Cid Menendez, A</au><au>Gonzalez Calle, D</au><au>Sanchez, P L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic factors and mortality predictive scale in patients treated with in-hospital extracorporeal cardiopulmonary resuscitation</atitle><jtitle>European heart journal</jtitle><date>2023-11-09</date><risdate>2023</risdate><volume>44</volume><issue>Supplement_2</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, evidence is limited and randomized studies are lacking regarding in-hospital CA.
Purpose
Our objective was the identification of factors associated with survival in in-hospital ECPR.
Methods
Retrospective analysis of consecutive cases of venoarterial extracorporeal membrane oxygenator (VA-ECMO) for ECPR indication in a referral center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analyzed baseline variables related to CA and ECPR technique and studied their relationship with in-hospital survival.
Results
Out of 207 VA-ECMO implants between 2014-feb 2023, we selected the ECPR cases: N=59 (28.5%). Baseline, admission and ECPR characteristics are collected in the table.
ECMO-VA support intention was bridge to recovery in 68% of cases, transplant 5%, ventricular assist device 5% and decision 22%. The most frequent access was percutaneous femoro-femoral, and ECPR was unsuccessful (no flow, no rhythm, or impossibility of cannulation in 11.8% of cases). All patients underwent temperature control at 36ºC with ECMO.
Overall in-hospital survival was 18.6% (n=11) (cerebral performance cathegory 1-2), and the most frequent causes of death were refractory shock/multiple organ failure (49%) and anoxic encephalopathy (25%).
The patients who died were significantly younger, had peripheral vascular disease (PAD), higher creatinine, LDH and lactate levels, longer CA duration, and its ECMO implantation was more frequent during on-call hours (table). Lactate >10.05 predicted mortality (AUC 0.693, Sens 67,3%, Esp 80%). The time under VA-ECMO support and mechanical ventilation, and the use of adrenaline infusion were more frequent in the survivors (table).
At multivariate analysis, a longer CA duration (HR 0.947, CI95% 0.900-0.977, p0,040) was the only factor independently associated with in-hospital mortality.
We developed a predictive scale including factors related to survival (lactate >10.05, >60 minutes CA, PAD, on-call time) which predicted 100% with 3 or more factors (p<0.001) (figure 2).
Conclusions
In-hospital ECPR is an option for refractory cardiac arrest, with high mortality. CA duration was the only factor independently associated with in-hospital mortality. Three or more adverse factors (lactate >10.05, >60 minutes CA, PAD, on-call time) predicted 100% mortality. Randomized studies are needed to determine a better selection of patientsBaseline, admission and ECPRMortality predictive scale after ECPR</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehad655.1570</doi><oa>free_for_read</oa></addata></record> |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| title | Prognostic factors and mortality predictive scale in patients treated with in-hospital extracorporeal cardiopulmonary resuscitation |
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