☆ 4.5 Article

Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest

RESUSCITATION (2021)

Journal

RESUSCITATION

Volume 162, Issue -, Pages 163-170

Publisher

ELSEVIER IRELAND LTD

DOI: 10.1016/j.resuscitation.2021.02.022

Keywords

Cardiac arrest; Heart arrest; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Advanced cardiac life support; Cardiopulmonary resuscitation

Funding

Emergency Department Research Association at Grenoble Alpes University Hospital

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Abstract

Analyzing the data from three cohort studies, this research examined the prevalence and prognostic value of signs of life before or throughout conventional CPR in individuals undergoing ECPR for refractory OHCA. The study found that individuals with any sign of life, pupillary light reaction, or increased level of consciousness had higher odds of 30-day survival with favorable neurological outcome. The lack of any sign of life might indicate patients without shockable cardiac rhythm could be excluded from receiving ECPR.

Purpose: Prognostication of refractory out-of-hospital cardiac arrest (OHCA) is essential for selecting the population that may benefit from extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to examine the prognostic value of signs of life before or throughout conventional CPR for individuals undergoing ECPR for refractory OHCA. Methods: Pooling the original data from three cohort studies, we estimated the prevalence of signs of life, for individuals with refractory OHCA resuscitated with ECPR. We performed multivariable logistic regression to examine the independent associations between the occurrence of signs of life and 30-day survival with a CPC score <= 2. Results: The analytical sample consisted of 434 ECPR recipients. The prevalence of any sign of life was 61%, including pupillary light reaction (48%), gasping (32%), or increased level of consciousness (13%). Thirty-day survival with favorable neurological outcome was 15% (63/434). In multivariable analysis, the adjusted odds ratios of 30-day survival with favorable neurological outcome were 7.35 (95% confidence interval [CI], 2.71-19.97), 5.86 (95% CI, 2.28-15.06), 4.79 (95% CI, 2.16-10.63), and 1.75 (95% CI, 0.95-3.21) for any sign of life, pupillary light reaction, increased level of consciousness, and gasping, respectively. Conclusion: The assessment of signs of life before or throughout CPR substantially improves the accuracy of a multivariable prognostic model in predicting 30-day survival with favorable neurological outcome. The lack of any sign of life might obviate the provision of ECPR for patients without shockable cardiac rhythm.

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Hydrogen gas with extracorporeal cardiopulmonary resuscitation improves survival after prolonged cardiac arrest in rats

Tai Yin, Lance B. Becker, Rishabh C. Choudhary, Ryosuke Takegawa, Muhammad Shoaib, Koichiro Shinozaki, Yusuke Endo, Koichiro Homma, Daniel M. Rolston, Shuhei Eguchi, Tadashi Ariyoshi, Asami Matsumoto, Kentaro Oka, Motomichi Takahashi, Tomoaki Aoki, Santiago J. Miyara, Mitsuaki Nishikimi, Junichi Sasaki, Junhwan Kim, Ernesto P. Molmenti, Kei Hayashida

Summary: This study demonstrated that the combination of H-2 gas with ECPR therapy improved survival rates in rats after CA/ECPR, enhanced brain electrical activity recovery, and alleviated endothelial damage. H-2 treatment also significantly improved brain tissue oxygenation during resuscitation and prevented an increase in central venous pressure post-ECPR.

JOURNAL OF TRANSLATIONAL MEDICINE (2021)