Background
Methods
Patients
ECMO equipment and management
Statistical analysis
Results
All | Non-survivors | Survivors |
p
| |
---|---|---|---|---|
N = 23 |
N = 13 |
N = 10 | ||
Age, years | 55 (40, 68) | 57 (46.5, 72.5) | 52 (35.5, 61) | 0.208 |
Gender, male (%) | 20 | 10 | 10 | 0.229 |
BMI | 22.8 (21.9, 26.1) | 22.9 (21.2, 28.1) | 22.6 (22.4, 24.1) | 0.648 |
Past medical history | ||||
Hypertension | 12 | 8 | 4 | 0.414 |
Diabetes | 12 | 8 | 4 | 0.414 |
Previous PCI | 4 | 3 | 1 | 0.604 |
Cerebral vascular accident | 2 | 1 | 1 | 1.000 |
Causes of cardiac arrest | 0.329 | |||
AMI | 15 | 8 | 7 | |
Anaphylactic shock | 3 | 3 | - | |
Arrhythmia | 2 | 1 | 1 | |
Commotio Cordis | 1 | - | 1 | |
Hypothermia | 1 | - | 1 | |
AAA rupture | 1 | 1 | - | |
Pre-ECMO laboratory findings | ||||
pH | 7.01 (6.80, 7.08) | 6.98 (6.80, 7.13) | 7.02 (6.97, 7.04) | 0.422 |
PaO2 | 33 (7, 54.5) | 10 (6, 42) | 51 (28, 70) | 0.009a
|
PaCO2 | 69 (55.5, 97.5) | 71 (64.5, 103) | 61 (37.5, 88) | 0.095 |
CK-MB | 6.1 (2.2, 15.73) | 4.4 (2.0, 24.2) | 6.1 (2.5, 7.6) | 0.976 |
Troponin-I | 0.17 (0.06, 3.25) | 0.17 (0.07, 6.15) | 0.17 (0.05, 1.03) | 0.522 |
BUN | 14.5 (11.3, 20.1) | 14.5 (12.1, 21.0) | 16.0 (9.2, 20.5) | 0.927 |
Creatinine | 1.2 (1.1, 1.4) | 1.3 (0.8, 1.4) | 1.2 (1.1, 1.5) | 0.784 |
Total bilirubin | 0.78 (0.59, 1.13) | 0.75 (0.57, 1.11) | 0.92 (0.7, 1.21) | 0.410 |
Lactate | 9.7 (7.7, 13.2) | 10.4 (8.4, 13.9) | 9.0 (6.9, 11.6) | 0.284 |
Pre-ECMO | ||||
SOFA score | 14 (13, 16) | 14 (13.5, 16) | 14 (12.8, 15.3) | 0.446 |
SAPS 2 score | 87 (80, 97) | 90 (83.5, 99.5) | 82.5 (75, 91.3) | 0.077 |
PCI | 15 (65.2 %) | 9 (69.2 %) | 6 (60 %) | 0.646 |
IABP | 0.604 | |||
Pre-ECMO | 2 | 1 | 1 | |
After-ECMO | 2 | 2 | - | |
CRRT | 18 | 10 | 8 | 1.000 |
All | Non-survivors | Survivors |
p
| |
---|---|---|---|---|
N = 23 |
N = 13 |
N = 10 | ||
Locations of victims | 0.472 | |||
Public | 15 | 10 | 5 | |
Home | 5 | 2 | 3 | |
In-ambulance during transportation | 2 | 1 | 1 | |
Other hospital | 1 | - | 1 | |
Time of collapse to CPR start, min | 1 (1, 5) | 4 (1, 6) | 1 (1, 1.75) | 0.166 |
Bystander CPR | 14 | 6 | 8 | 0.197 |
First monitored rhythm | 0.685 | |||
Shockable | 10 | 5 | 5 | |
Non-shockable | 13 | 8 | 5 | |
Transport time from collapse to hospital, min | 22 (15, 38) | 22 (15, 51) | 21 (13, 30) | 0.910 |
EKG rhythm on arrival at ED | 0.177 | |||
Vf/VT | 20 | 12 | 8 | |
PEA | 2 | - | 2 | |
Asystole | 1 | 1 | - | |
Collapse to ECMO time, min | 84 (61, 101) | 94 (72.5, 127) | 64.5 (55.25, 89.75) | 0.101 |
CPR time, min | 62 (53, 86) | 66 (58.5, 108) | 57.5 (40.5, 73.75) | 0.101 |
ROSC ≥ 20 min during CPR | 3 | 2 | 1 | 1.000 |
Door to ECMO time, min | 55 (41, 67) | 62 (49, 71.5) | 45 (32.5, 56.5) | 0.030a
|
ROSB at ICU arrival | 17 | 10 | 7 | 1.000 |
Pre-ECMO VIS | 41.0 (16.4, 76.2) | 63.5 (0, 93.8) | 39.6 (31.7, 71.6) | 0.832 |
Post-ECMO VIS; at 6 h on ICU arrival | 7.6 (0, 22.6) | 11.3 (3.4, 58.4) | 0 (0, 7.8) | 0.030a
|
24 h urine output (ml · kg−1 · h−1) | 0.92 (0.03, 2.33) | 0.1 (0–0.92) | 2.39 (1.59, 3.86) | <0.001a
|
Pupil diameter on arrival at ED, mm | 6 (6, 7) | 7 (6, 7) | 6 (3.5, 7.25) | 0.414 |
Pupil reflex positive after ECMO | 15 | 6 | 10 | 0.007a
|
Hypothermia for 24 h | 18 | 12 | 6 | 0.127 |
ECMO duration, h | 98 (60, 192) | 75 (18.5, 122) | 151 (97.25,219.25) | 0.008a
|
CPC grade | ||||
1 | 7 | |||
4 | 3 |
Brain CT just after ECMO | FU brain image | Outcomes | Total | |
---|---|---|---|---|
Death | Survival | |||
N = 13 |
N = 10 |
N = 23 | ||
Hypoxic brain damage (−) n = 9 | Hypoxic brain damage (−) | - | 3 | 3 |
Hypoxic brain damage (+) | 1 | 3 | 4 | |
ICH due to hypoxic brain damage | 2 | - | 2 | |
Hypoxic brain damage (+) n = 11 | Hypoxic brain damage (+) | 6 | 3 | 9 |
ICH due to hypoxic brain damage | 2 | - | 2 | |
Check (−) n = 3 | Check (−) | 2 | 1 | 3 |
All (N-=23) | Non-survivors (N=13) | Survivors (N=10) |
p
| |
---|---|---|---|---|
CPR-related complication | ||||
Chest wall compartment syndrome | 1 | 1 | - | 1.000 |
Pneumothorax | 2 | 1 | 1 | 1.000 |
Chylothorax | 1 | - | 1 | 0.435 |
Pulmonary hemorrhage | 2 | 2 | - | 0.486 |
Hypoxic brain damage | 14 | 11 | 3 | 0.001a
|
Cannula related complication | ||||
Cannula site bleeding, ≥ 2 units/d pRBC transfusion | 3 | 3 | - | 0.229 |
Leg ischemia d/t septic emboli and right common iliac artery obstruction | 2 | - | 2 | 0.178 |
Acute renal failure | 11 | 6 | 5 | 1.000 |
Ulcer bleeding | 1 | 1 | - | 1.000 |
Pneumonia | 15 | 5 | 10 | 0.003a
|
ICH d/t hypoxic brain damage | 4 | 4 | - | 0.104 |
Sore | 4 | - | 4 | 0.024a
|
Sepsis | 5 | 2 | 3 | 0.618 |
Variables | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
OR | 95 % CI |
p
| OR | 95 % CI |
p
| |
Pre-ECMO PaO2 | 0.946 | 0.901–0.993 | 0.025a
| 0.936 | 0.873–1.005 | 0.068 |
24 h urine output ≤ 0.5 mL · kg−1 · h−1
| 20.250 | 1.878–218.390 | 0.013a
| 32.271 | 1.379–755.282 | 0.031a
|
Discussion
No. of patients | Survival Rate, n (%) | Neurological Outcome, n (%) | Remark | |
---|---|---|---|---|
Kagawa et al. 2010 [1] | 39 | 30 day 5 (13) | CPC 1–2 4 (10) | Time interval from collapse to ECLS start, min (IQR); 59(45–65). Successful percutaneous cannulation (38/39; 97 %). Complications after ECLS; cannula site bleeding (23/39; 59 %), acute kidney injury (9/39; 23 %), leg malperfusion (8/39; 21 %), pneumonia (7/39; 18 %), sepsis (3/39; 8 %). |
Le Guen et al. 2011 [2] | 42 | 28 day 2 (4) | CPC 1–2 2 (4) | 24 h survival rate after ECLS (17/42; 40 %). 48 h survival rate after ECLS (5/42; 12 %). 28 day survival rate after ECLS (2/42; 4 %). |
Avalli et al. 2012 [3] | 18 | 28 day 1(5) | GOS ≥ 4 1 (5) | Survival rate of patients with OHCA (1/18; 5 %) lower than IHCA (11/24; 46 %). Low flow time of OHCA (77 min) longer than IHCA (55 min). Cannulation failure: two in OHCA (2/18; 11 %) In OHCA, complications ECMO; distal leg perfusion (4/18; Haneya22%), femoral leg lesion (2/18; 11 %). |
Haneya et al. 2012 [29] | 26 | Survival discharge 6 (23.1) | Forty patients (47 %) were successfully weaned and 29 patients (34 %) survived to hospital discharge. | |
Maekawa et al. 2013 [5] | 53 | 3 mon 15 (28.3) | CPC 1 or 2 at 3mon: 8 (15.1) | Survival rate at 3 months (15/53; 28.3 %) Complications after ECLS; cannulation site bleeding (17/52; 32.7 %), cannulation site infection (4/52; 7.7 %). Pupil diameter on hospital arrival may be associated with the neurologic outcome. |
Leick et al. 2013 [4] | 28 | 11 (39.3) | No check | Door to ECLS implantation time < 30 min → significantly improved the 30 day survival Complications after ECLS; bleeding (9/28; 32 %), lower limb ischemia (1/28; 3.6 %). |
Sakamoto et al. 2014 [30] | 260 | 32 (12.3) | ECPR 26 hospitals vs. non-ECPR 20 hospitals CPC 1–2 at 1 months: 12.3 vs. 1.5 % CPC 1–2 at 6 moths: 11.2 vs. 2.6 % | |
Stub et al. 2014 [31] | 9 | Survival discharge 3 (33.3) | CPC 1 or 2 at discharge 3 (33.3) | CHEER trial (11 with OHCA, 15 with IHCA) CPC score 1: 14/26 (54 %) collapse to initiation of ECMO: 56 min |
Our results | 23 | 30 day 10 (43.5) | CPC 1: 7 (30) CPC 4: 3 (13) | Door to ECMO team activation time < 10 min for refractory OHCA. Rapid and accurate ECMO implantation in the catheter laboratory. Complications after ECLS; cannulation site bleeding (3/23; 13 %). Oliguria may be a predictor for mortality. Brain CT just after ECMO and following brain imaging may be a predictor for neurologic outcome. |