Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane oxygenation: An observational study and propensity-score analysis.

Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock. Using a large regional registry, we focused on all CA admitted in ICU. Among those who developed a post-CA shock, prognostic was compared according to VA-ECMO use, using logistic regression and propensity score. Specific prognostic factors were identified among VA-ECMO patients. Among 2988 patients admitted after CA, 1489 developed a post-CA shock, and were included. They were mostly male (68%), with mean age 63 years (SD=15). Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were discharged alive (25% in VA-ECMO group, 21% in control group, P=0.45). After adjustment for pre-hospital and in-hospital factors, survival did not differ among patients treated with VA-ECMO (OR for survival=0.9, 95%CI 0.4-2.3, P=0.84). After propensity-score matching, results were consistent. Among patients treated with VA-ECMO, initial arterial pH (OR=1.7 per 0.1 increase, 95%CI 1.0-2.8, P=0.04) and implantation of VA-ECMO over 24h after ROSC (OR=20.0, 95%CI 1.4-277.3, P=0.03) were associated with survival. Post-CA shock is frequent and is associated with a high mortality rate. When used in selected patients, we observed that VA-ECMO could be an appropriate treatment.

Bougouin W ，Aissaoui N ，Combes A ，Deye N ，Lamhaut L ，Jost D ，Maupain C ，Beganton F ，Bouglé A ，Karam N ，Dumas F ，Marijon E ，Jouven X ，Cariou A ，SDEC Investigators ... -  《-》

Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest.

Pineton de Chambrun M ，Bréchot N ，Lebreton G ，Schmidt M ，Hekimian G ，Demondion P ，Trouillet JL ，Leprince P ，Chastre J ，Combes A ，Luyt CE ... -  《-》

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1-2). There were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPR patients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CS patients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPR patients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition. The initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes.

Sun T ，Guy A ，Sidhu A ，Finlayson G ，Grunau B ，Ding L ，Harle S ，Dewar L ，Cook R ，Kanji HD ... -  《-》

Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can improve survival in patients with cardiogenic shock or cardiac arrest. We investigated the association between initial renal function and clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest. This was a single-center, retrospective cohort study of 287 patients who underwent ECMO at our hospital from January 2005 to December 2014. We excluded 70 patients with non-cardiogenic events. The remaining 217 patients were divided into 2 groups according to initial estimated glomerular filtration rate (eGFR): Initial high eGFR (non-renal failure: non-RF) group: eGFR≥60ml/min/1.73m2 (n=73) and initial low eGFR (RF) group: eGFR<60ml/min/1.73m2 (n=144). Clinical outcome was defined as all-cause death at 30 days after extracorporeal life support. VA-ECMO was begun in 87% of patients for cardiac arrest. The non-RF group was significantly younger (51.6 vs. 62.6 years), had lower body mass index (22.8 vs. 24.7kg/m2), lower blood urea nitrogen (14.4 vs. 23.9mg/dl), and lower K (4.0 vs. 4.5mEq/l, all p<0.05) than the RF group. Incidence of all-cause death at 30 days was significantly lower in the non-RF than RF group (49% vs. 76%, p<0.0001). Initial low eGFR was an independent predictor of mortality after adjustment for multiple cofounders (OR: 4.08, 95% CI: 1.77-9.42, p<0.001). Kaplan-Meier curve showed better outcome in the non-RF versus RF group (p=0.0009). An initial low eGFR may predict worse clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest.

Kuroki N ，Abe D ，Iwama T ，Sugiyama K ，Akashi A ，Hamabe Y ，Aonuma K ，Sato A ... -  《-》

Contemporary Use of Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Acute Coronary Syndrome.

Negi SI ，Sokolovic M ，Koifman E ，Kiramijyan S ，Torguson R ，Lindsay J ，Ben-Dor I ，Suddath W ，Pichard A ，Satler L ，Waksman R ... -  《-》