Clinical outcomes in patients with acute hemodynamic collapse supported by extracorporeal life support.
Although extracorporeal life support (ECLS) is utilized for acute hemodynamic collapse, clinical outcomes for such patients are uncertain. The present study examined 30-day clinical outcomes in patients treated with ECLS for acute hemodynamic collapse, and determined the factors associated with 30-day mortality in patients who required ECLS for cardiopulmonary arrest (CPA). A total of 200 patients, in whom emergency ECLS was utilized for acute hemodynamic collapse from 2006 to 2015, were analyzed retrospectively. The impact of CPA on all-cause 30-day death in the overall population was examined by multivariable logistic regression analysis; comparisons were made between 30-day survivors (n = 78) and non-survivors (n = 122). In addition, clinical factors associated with 30-day survival for patients in whom ECLS was utilized for CPA (n = 139) were examined. All-cause 30-day mortality in the overall study population was 61 % (122/200). CPA was the most common cause of ECLS requirement (70 %), and the factor associated strongest with death at 30-days (OR 3.31, 95 % CI 1.75-6.36, P < 0.01). Witnessed CPA with bystander cardiopulmonary resuscitation (CPR) (OR 4.33, 95 % CI 1.08-29.1, P = 0.04) and a less than 40 min interval between CPA and ECLS (OR 3.49, 95 % CI 1.39-9.02, P < 0.01) were suggested as factors associated with 30-day survival in CPA patients. CPA as a trigger of ECLS was a strong contributor to 30-day death in patients in whom emergency ECLS was utilized. However, witnessed CPA with bystander CPR and a less than 40 min interval from CPA to start of ECLS were suggested as factors associated with survival in these CPA patients.
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Toshiharu
T
Fujii
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Hirofumi
H
Nagamatsu
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Masataka
M
Nakano
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Yohei
Y
Ohno
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Gaku
G
Nakazawa
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Norihiko
N
Shinozaki
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Fuminobu
F
Yoshimachi
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan. ikari@is.icc.u-tokai.ac.jp.
Yuji
Y
Ikari
D000368:Aged; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
Cardiopulmonary arrest; Cardiopulmonary resuscitation; Extracorporeal life support; Mortality
Resuscitation. 2014 Jun;85(6):762-8
24530251
Crit Care. 2014 Sep 26;18(5):535
25255842
J Am Coll Cardiol. 2004 Sep 15;44(6):1268-75
15364331
Can J Cardiol. 2004 Sep;20(11):1081-90
15457303
Lancet. 2007 Mar 17;369(9565):920-6
17368153
N Engl J Med. 2015 Jun 11;372(24):2307-15
26061835
Crit Care Med. 2012 Apr;40(4):1192-8
22202708
Curr Opin Crit Care. 2013 Jun;19(3):202-7
23587757
Ann Emerg Med. 1990 Feb;19(2):179-86
2301797
Circulation. 2001 Oct 30;104(18):2158-63
11684624
Circ J. 2010 Jan;74(1):77-85
19942784
Resuscitation. 1995 Feb;29(1):33-9
7784721
Resuscitation. 2007 Jan;72(1):59-65
17113209
Resuscitation. 2000 Oct;47(2):137-46
11008151
Circulation. 2010 Nov 2;122(18 Suppl 3):S685-705
20956221
Resuscitation. 2003 Jul;58(1):89-96
12867314
Heart. 1999 Dec;82(6):674-9
10573491
Ann Emerg Med. 1999 Oct;34(4 Pt 1):517-25
10499952
Ann Emerg Med. 1993 Feb;22(2 Pt 2):324-49
8434832
Circulation. 2016 Jan 26;133(4):e38-360
26673558
Circ Arrhythm Electrophysiol. 2014 Apr;7(2):212-7
24610738
JAMA. 2008 Sep 24;300(12):1423-31
18812533
Resuscitation. 2015 Oct;95:e71-120
26477429
Circ J. 2013;77(8):2064-72
23615051
Ann Thorac Surg. 1983 Aug;36(2):223-5
6882082
Circulation. 2010 Nov 2;122(18 Suppl 3):S720-8
20956223
Resuscitation. 2011 Jan;82(1):10-4
20934798
Crit Care Med. 1985 Nov;13(11):927-9
4053642
Clin Res Cardiol. 2013 Sep;102(9):661-9
23657432
Lancet. 2008 Aug 16;372(9638):554-61
18603291
Ann Fr Anesth Reanim. 2009 Feb;28(2):182-90
19232884