Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care

Peter Hasse Møller-Sørensen¹  Sisse Anette Thomassen²  Jo Bønding Andreasen²  Helle Laugesen²  Steffen Christensen³  Jacob Raben Greisen³  Henrik Schmidt⁴  Phillip Michael Freeman⁵  Carsten Stengaard⁶  Hans Eiskjær⁶  Sivagowry Rasalingam Mørk⁶  Christian Juhl Terkelsen⁷  Lene Holmvang⁸  Jesper Kjaergaard⁸  Christian Hassager⁸  Emilie Gregers⁸  Louise Linde⁹  Jacob Eifer Møller⁹  Lisette Okkels Jensen⁹  Mariann Tang^1,10  Lars Peter Riber^1,11 

[1] Cardiothorascic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark;Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark;Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark;Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark;Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark;Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark;Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark;The Danish Heart Foundation, Copenhagen, Denmark;Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark;Department of Cardiology, Odense University Hospital, Odense, Denmark;Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark;Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark;

关键词: Out-of-hospital cardiac arrest;    Mechanical circulatory support;    Extracorporeal membrane oxygenation;    Impella;    Cardiopulmonary resuscitation;   

DOI  :  10.1186/s13054-021-03606-5

来源: Springer

【 摘 要 】

BackgroundMechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome.MethodsThis retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality.ResultsA total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76).ConclusionsA high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

【 授权许可】

CC BY