Log in | Register

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

Marc Pineton de Chambrun| Nicolas Bréchot| Guillaume Lebreton| Matthieu Schmidt| Guillaume Hekimian| Pierre Demondion| Jean-Louis Trouillet| Pascal Leprince| Jean Chastre| Alain Combes| Charles-Edouard Luyt
Original
Volume 42, Issue 12 / December , 2016

Pages 1999 - 2007

Abstract

Purpose

To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest.

Methods

We retrospectively analyzed data collected prospectively (March 2007–January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded.

Results

Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4–17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7–16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1–0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results.

Conclusion

Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation.

Keywords

References

  1. Donnino MW, Miller JC, Bivens M et al (2012) A pilot study examining the severity and outcome of the post-cardiac arrest syndrome: a comparative analysis of two geographically distinct hospitals. Circulation 126:1478–1483. doi:10.1161/CIRCULATIONAHA.111.067256
    • View reference on publisher's website
    • View reference on PubMed
  2. Adrie C, Cariou A, Mourvillier B et al (2006) Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score. Eur Heart J 27:2840–2845. doi:10.1093/eurheartj/ehl335
    • View reference on publisher's website
    • View reference on PubMed
  3. Girotra S, Nallamothu BK, Spertus JA et al (2012) Trends in survival after in-hospital cardiac arrest. N Engl J Med 367:1912–1920. doi:10.1056/NEJMoa1109148
    • View reference on publisher's website
    • View reference on PubMed
  4. Eisenberg MS, Mengert TJ (2001) Cardiac resuscitation. N Engl J Med 344:1304–1313. doi:10.1056/NEJM200104263441707
    • View reference on publisher's website
    • View reference on PubMed
  5. Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348:2626–2633. doi:10.1056/NEJMoa023053
    • View reference on publisher's website
    • View reference on PubMed
  6. Bernard SA, Gray TW, Buist MD et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563. doi:10.1056/NEJMoa003289
    • View reference on publisher's website
    • View reference on PubMed
  7. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556. doi:10.1056/NEJMoa012689
    • View reference on publisher's website
  8. Bougouin W, Lamhaut L, Marijon E et al (2014) Characteristics and prognosis of sudden cardiac death in Greater Paris. Intensive Care Med 40:846–854. doi:10.1007/s00134-014-3270-3
  9. Citerio G, Bakker J, Bassetti M et al (2015) Year in review in Intensive Care Medicine 2014: I. Cardiac dysfunction and cardiac arrest, ultrasound, neurocritical care, ICU-acquired weakness, nutrition, acute kidney injury, and miscellaneous. Intensive Care Med 41:179–191. doi:10.1007/s00134-015-3665-9
  10. Paul M, Bougouin W, Geri G et al (2016) Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry. Intensive Care Med 42:1128–1136. doi:10.1007/s00134-016-4349-9
  11. Mongardon N, Dumas F, Ricome S et al (2011) Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome. Ann Intensive Care 1:45. doi:10.1186/2110-5820-1-45
    • View reference on publisher's website
    • View reference on PubMed
  12. Nolan JP, Neumar RW, Adrie C et al (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation 79:350–379. doi:10.1016/j.resuscitation.2008.09.017
    • View reference on publisher's website
    • View reference on PubMed
  13. Perner A, Citerio G, Bakker J et al (2015) Year in review in Intensive Care Medicine 2014: II. ARDS, airway management, ventilation, adjuvants in sepsis, hepatic failure, symptoms assessment and management, palliative care and support for families, prognostication, organ donation, outcome, organisation and research methodology. Intensive Care Med 41:389–401. doi:10.1007/s00134-015-3707-3
  14. Timsit J-F, Perner A, Bakker J et al (2015) Year in review in Intensive Care Medicine 2014: III. Severe infections, septic shock, healthcare-associated infections, highly resistant bacteria, invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics. Intensive Care Med 41:575–588. doi:10.1007/s00134-015-3755-8
  15. Schmidt M, Burrell A, Roberts L et al (2015) Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 36:2246–2256. doi:10.1093/eurheartj/ehv194
    • View reference on publisher's website
    • View reference on PubMed
  16. Mirabel M, Luyt C-E, Leprince P et al (2011) Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 39:1029–1035. doi:10.1097/CCM.0b013e31820ead45
    • View reference on publisher's website
    • View reference on PubMed
  17. Combes A, Leprince P, Luyt C-E et al (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411. doi:10.1097/CCM.0b013e31816f7cf7
    • View reference on publisher's website
    • View reference on PubMed
  18. Le Guen M, Nicolas-Robin A, Carreira S et al (2011) Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care 15:R29. doi:10.1186/cc9976
    • View reference on publisher's website
    • View reference on PubMed
  19. Abrams D, Combes A, Brodie D (2014) What’s new in extracorporeal membrane oxygenation for cardiac failure and cardiac arrest in adults? Intensive Care Med 40:609–612. doi:10.1007/s00134-014-3212-0
  20. Xie A, Phan K, Tsai Y-C et al (2015) Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth 29:637–645. doi:10.1053/j.jvca.2014.09.005
    • View reference on publisher's website
    • View reference on PubMed
  21. Aissaoui N, Luyt C-E, Leprince P et al (2011) Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 37:1738–1745. doi:10.1007/s00134-011-2358-2
  22. Beurtheret S, Mordant P, Paoletti X et al (2013) Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program). Eur Heart J 34:112–120. doi:10.1093/eurheartj/ehs081
    • View reference on publisher's website
    • View reference on PubMed
  23. Luyt CE, Bréchot N, Demondion P et al (2016) Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 42:897–907. doi:10.1007/s00134-016-4318-3
  24. Rittenberger JC, Raina K, Holm MB et al (2011) Association between cerebral performance category, modified rankin scale, and discharge disposition after cardiac arrest. Resuscitation 82:1036–1040. doi:10.1016/j.resuscitation.2011.03.034
    • View reference on publisher's website
    • View reference on PubMed
  25. Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30:2126–2128. doi:10.1007/s00134-004-2425-z
  26. Laurent I, Monchi M, Chiche J-D et al (2002) Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40:2110–2116
    • View reference on publisher's website
    • View reference on PubMed
  27. Lemiale V, Dumas F, Mongardon N et al (2013) Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med 39:1972–1980. doi:10.1007/s00134-013-3043-4
  28. Ruiz-Bailén M, Aguayo de Hoyos E, Ruiz-Navarro S et al (2005) Reversible myocardial dysfunction after cardiopulmonary resuscitation. Resuscitation 66:175–181. doi:10.1016/j.resuscitation.2005.01.012
    • View reference on publisher's website
    • View reference on PubMed
  29. Thiele H, Zeymer U, Neumann F-J et al (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296. doi:10.1056/NEJMoa1208410
    • View reference on publisher's website
    • View reference on PubMed
  30. Manzo-Silberman S, Fichet J, Mathonnet A et al (2013) Percutaneous left ventricular assistance in post cardiac arrest shock: comparison of intra aortic blood pump and Impella Recover LP2.5. Resuscitation 84:609–615. doi:10.1016/j.resuscitation.2012.10.001
    • View reference on publisher's website
    • View reference on PubMed
  31. Mukku VK, Cai Q, Gilani S et al (2012) Use of impella ventricular assist device in patients with severe coronary artery disease presenting with cardiac arrest. Int J Angiol 21:163–166. doi:10.1055/s-0032-1324736
    • View reference on publisher's website
    • View reference on PubMed
  32. Muller G, Flecher E, Lebreton G et al (2016) The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med 42:370–378. doi:10.1007/s00134-016-4223-9

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement