Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane oxygenation: An observational study and propensity-score analysis

详细信息    查看全文

• 作者：Wulfran Bougouin^a ; ^b ; ^c ; ^d ; Nadia Aissaoui^c ; ^e ; Alain Combes^f ; Nicolas Deye^g ; ^h ; Lionel Lamhaut^b ; ^c ; ^d ; ⁱ ; Daniel Jost^d ; ^j ; Carole Maupain^k ; Frankie Beganton^b ; ^c ; ^d ; Adrien Bouglé ; ^l ; ^m ; Nicole Karam^a ; ^b ; ^c ; ^d ; Florence Dumas^b ; ^c ; ^d ; ⁿ ; Eloi Marijon^a ; ^b ; ^c ; ^d ; Xavier Jouven^a ; ^b ; ^c ; ^d ; Alain Cariou^b ; ^c ; ^d ; ^o ; ^{alain.cariou@cch.aphp.fr} ; on behalf SDEC Investigators
• 关键词：CA ; cardiac arrest ; CPC ; cerebral performance category ; CPR ; cardio-pulmonary resuscitation ; VA-ECMO ; veno-arterial extra-corporeal membrane oxygenation ; EMS ; emergency medical service ; ESM ; electronic supplementary material ; ICU ; intensive-care-unit ; IQR ; interquartile-range ; PCI ; percutaneous coronary intervention ; PRMD ; post resuscitation myocardial dysfunction ; ROSC ; return of spontaneous circulation ; SD ; standard-deviation ; TTM ; targeted temperature management
• 刊名：Resuscitation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：110
• 期：Complete
• 页码：126-132
• 全文大小：704 K
• 卷排序：110

文摘

Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock.MethodsUsing a large regional registry, we focused on all CA admitted in ICU. Among those who developed a post-CA shock, prognostic was compared according to VA-ECMO use, using logistic regression and propensity score. Specific prognostic factors were identified among VA-ECMO patients.ResultsAmong 2988 patients admitted after CA, 1489 developed a post-CA shock, and were included. They were mostly male (68%), with mean age 63 years (SD = 15). Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were discharged alive (25% in VA-ECMO group, 21% in control group, P = 0.45). After adjustment for pre-hospital and in-hospital factors, survival did not differ among patients treated with VA-ECMO (OR for survival = 0.9, 95%CI 0.4–2.3, P = 0.84). After propensity-score matching, results were consistent. Among patients treated with VA-ECMO, initial arterial pH (OR = 1.7 per 0.1 increase, 95%CI 1.0–2.8, P = 0.04) and implantation of VA-ECMO over 24 h after ROSC (OR = 20.0, 95%CI 1.4–277.3, P = 0.03) were associated with survival.ConclusionsPost-CA shock is frequent and is associated with a high mortality rate. When used in selected patients, we observed that VA-ECMO could be an appropriate treatment.