ECMO during CPR might be the future

[Planktonmd]

I found this article very interesting:

Clinical Investigations Critical Care Medicine. 36(9):2529-2535, September 2008.
Chen, Yih-Sharng MD; Yu, Hsi-Yu MD; Huang, Shu-Chien MD; Lin, Jou-Wei MD; Chi, Nai-Hsin MD; Wang, Chih-Hsien MD; Wang, Shoei-Shan MD; Lin, Fang-Yue MD; Ko, Wen-Je MD
Abstract:
Objectives: To evaluate the use of extracorporeal membrane oxygenation in prolonged cardiopulmonary resuscitation and to estimate how long cardiopulmonary resuscitation can be extended with acceptable results.
Design: Review of consecutive adult in-hospital cardiopulmonary resuscitation patients without return of spontaneous circulation in 10 mins and with extracorporeal membrane oxygenation rescue, and analysis of the relationship between outcome and cardiopulmonary resuscitation duration and possible etiologies. The data were collected following the Utstein style guidelines on in-hospital cardiopulmonary resuscitation. Two organ dysfunction scores were incorporated into the analysis for outcome prediction.
Setting: A university-affiliated tertiary referral medical center and extracorporeal membrane oxygenation center.
Patients: An observational cohort study in 135 consecutive adult in-hospital cardiopulmonary resuscitation patients without return of spontaneous circulation who received extracorporeal membrane oxygenation during cardiopulmonary resuscitation.
Main Results: The average cardiopulmonary resuscitation duration was 55.7 +/- 27.0 mins and 56.3% of patients received subsequent interventions to treat underlying etiologies. The successful weaning rate was 58.5% and the survival-to-discharge rate was 34.1%. The majority of survivors (89%) had an acceptable neurologic status on discharge. Risk factors for hospital mortality included longer cardiopulmonary resuscitation duration, etiology of acute coronary syndrome, and a higher organ dysfunction score in the first 24 hrs. Logistic regression analysis revealed the probability of survival was approximately 0.5, 0.3, or 0.1 when the duration of cardiopulmonary resuscitation was 30, 60, or 90 mins, respectively.
Conclusion: Assisted circulation might extend the presently accepted duration of cardiopulmonary resuscitation in adult in-hospital cardiopulmonary resuscitation patients.

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[coprolalia]

We tried this at our institution. No change in 30-day mortality.

Nice thought, though.

-copro

 

[seinfeld]

ECMO, the new CPR

These kind of studies are important because as technology grows and we find more possible uses , we need to define appropriate uses. It keeps getting harder and harder to say we have done everything when you have ecmo and have not used it yet.

Anyone heard of ELAD?.... extracoporeal liver assist device http://www.vitaltherapies.com/index.html

I just can wait for the EBiRD (extracoporeal brain replacement device), i know some people who work in the hospital who could use that 😛

BTW i have seen people live using ecmo in cardiogenic shock and Hypoxemia from a PE

 

[Planktonmd]

ECMO, the new CPR

These kind of studies are important because as technology grows and we find more possible uses , we need to define appropriate uses. It keeps getting harder and harder to say we have done everything when you have ecmo and have not used it yet.

Anyone heard of ELAD?.... extracoporeal liver assist device http://www.vitaltherapies.com/index.html

I just can wait for the EBiRD (extracoporeal brain replacement device), i know some people who work in the hospital who could use that 😛

BTW i have seen people live using ecmo in cardiogenic shock and Hypoxemia from a PE

I think the idea of using ECMO in this context is fascinating because it makes you think that maybe one day CPR as we know it might become a completely different process, maybe one day if your heart stops the first they will do is hook you to a machine that keeps you alive while they treat the cause.

 

[RxBoy]

I heard that reducing body temp of patient in cardiac arrest substantially delays brain injury.

And by heard, I mean watched on the discovery channel. 😀

 

[dfk]

I heard that reducing body temp of patient in cardiac arrest substantially delays brain injury.

And by heard, I mean watched on the discovery channel. 😀

exactly..
and at what point
is ischemia a factor?

i think the peds are on to something here
with the ecmo jazz..

 

[leviathan]

I heard that reducing body temp of patient in cardiac arrest substantially delays brain injury.

And by heard, I mean watched on the discovery channel. 😀

Only three things that have ever increased survival to discharge are early bystander CPR, early defibrillation, and post-arrest hypothermia.