Home > Uncategorized > ECMO, Hypothermia and Early Reperfusion in Refractory Cardiac Arrest

ECMO, Hypothermia and Early Reperfusion in Refractory Cardiac Arrest

The use of ECMO in refractory cardiac arrest came up in discussion at Angiography meeting. This paper provided promising results. The abstract follows:

Introduction

Many patients who suffer cardiac arrest do not respond to standard cardiopulmonary
resuscitation. There is growing interest in utilizing veno-arterial extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) in the management of refractory cardiac arrest. We describe our preliminary experiences in establishing an E-CPR program for refractory cardiac arrest in Melbourne, Australia.

Methods

The CHEER trial (mechanical CPR, Hypothermia, ECMO and Early Reperfusion) is a single center,
prospective, observational study conducted at The Alfred Hospital. The CHEER protocol was developed for selected patients with refractory in-hospital and out-of-hospital cardiac arrest and involves mechanical CPR, rapid intravenous administration of 30 mL/kg of ice-cold saline to induce intra-arrest therapeutic hypothermia, percutaneous cannulation of the femoral artery and vein by two critical care physicians and commencement of veno-arterial ECMO. Subsequently, patients with suspected coronary artery occlusion are transferred to the cardiac catheterization laboratory for coronary angiography. Therapeutic hypothermia (33 ◦C) is maintained for 24 h in the intensive care unit.

Results

There were 26 patients eligible for the CHEER protocol (11 with OHCA, 15 with IHCA). The median
age was 52 (IQR 38–60) years. ECMO was established in 24 (92%), with a median time from collapse until initiation of ECMO of 56 (IQR 40–85) min. Percutaneous coronary intervention was performed on 11 (42%) and pulmonary embolectomy on 1 patient. Return of spontaneous circulation was achieved in 25 (96%) patients. Median duration of ECMO support was 2 (IQR 1–5) days, with 13/24 (54%) of patients successfully weaned from ECMO support. Survival to hospital discharge with full neurological recovery (CPC score 1) occurred in 14/26 (54%) patients.

Conclusions

A protocol including E-CPR instituted by critical care physicians for refractory cardiac arrest
which includes mechanical CPR, peri-arrest therapeutic hypothermia and ECMO is feasible and associated with a relatively high survival rate.

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