43% cardiac arrest survival?Promising ECMO strategy in early research

Extracorporeal Membrane Oxygenation (ECMO) may improve survival in the case of out-of-hospital cardiac arrest (OHCA) that does not respond to initial resuscitation attempts, suggests the results of two studies published Friday Did.

With 30 patients Phase II trial called ARREST6 of 14 patients randomized to early ECMO-promoted resuscitation survived to discharge compared to 1 of 15 patients treated with standard advanced CPR (43% vs. 7%).

Given that there is a 36.2% risk difference with a Bayesian ECMO posterior probability of 0.9861, Demetris Yannopoulos, MD of the University of Minnesota, Minnesota, reported virtually. American Heart Association Conference Online at the same time Lancet..

The same group reported the same survival rate when ECMO interventions for OHCA were introduced in a community environment.

Survivors of the ARREST trial were ill and debilitated due to long and complex hospitalizations, but their neurological function was largely maintained, “follow-up visits 3 and 6 months after physiotherapy,” the group said. Consistent recovery and improvement were observed in and rehabilitation was performed. “

In the ECMO group, the 6-month modified Rankin score was 3 for 1 patient, 2 for 2 patients, 1 for 2 patients, and 0 for 1 patient. The only survivor in the standard treatment group did so with a modified Rankin score of 5 and died before 3 months of follow-up.

“The survival rate from cardiac arrest remained poor for decades,” the group noted, adding that the survival rate of their control group was comparable to previous studies.

“ECMO-promoted resuscitation ensures normalization of perfusion, provides cardiopulmonary support, and provides consistent access to catheterization laboratories for angiography, the most common causes of refractory arrest (chronic and chronic). Facilitates the identification and treatment of (severe coronary artery disease) with acute coronary occlusion. Angiography is performed as needed, and multiple organ damage during prolonged resuscitation accelerates exacerbations and death. It will be a bridge to recovery in ICU when it is possible, “the researchers say.

“Therefore, it is important to note that early implementation of ECMO is a prerequisite that allows us to provide additional advanced targeted therapies to these critical patients. In the absence of ECMO, Is impossible. “

However, this strategy needs to be clearly demonstrated in multicenter Phase III trials before broader implementation. “But only after the program has matured and reconstructed the systemic response to these patients,” they admitted.

so Related papers Clinical medicine, Yannopoulos et al. Elaborated on the results after a similar program was launched in Minneapolis-Cent. Pole area with a mobile ECMO cannula team 24 hours a day, 7 days a week.I also achieved that 43% functionally favorable survival A percentage of 58 patients treated that meet the specified criteria for 3 months in brain function category 1 or 2.

Their early ECMO strategy was OHCA with refractory ventricular fibrillation, which shocked patients who underwent automatic cardiopulmonary resuscitation with the Lund University Cardiac Arrest System and were transferred to the hospital within 30 minutes. Later, the spontaneous circulation did not recover.

When you get there, the patient Immediately taken to the cardiac catheterization laboratory If arterial blood gas was good, regardless of pulse, peripheral venous artery ECMO support and angiography were performed and angiogenesis was performed as clinically indicated.

Patients on standard treatment stayed in the emergency department for at least 15 minutes of continuous treatment or at least 60 minutes after a 911 call. Patients who achieved pulse or spontaneous circulation at any time during resuscitation were transferred for angiography, angioplasty, and circulatory assistance as needed.

Those who survived hospitalization were similarly treated with dedicated cardiac ICUs in both groups. CPR lasted nearly 60 minutes on average.

Initiating ECMO at Caslab took advantage of the expertise of intervention cardiologists on large-diameter percutaneous vascular access and the immediate availability of fluorescence fluoroscopy and ultrasound vascular access guidance. The Yannopoulos group adds a layer of safety and minimizes vascular access complications.

“This can serve as a model, but it’s not the only approach that can be successful,” they write.