ABSTRACT
@#Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
ABSTRACT
The survival of cardiac arrest patients is dependent on the efficient and timely application of the chain of survival. This includes early identification of cardiac arrest and activation of the emergency response system, high-quality cardiopulmonary resuscitation (CPR), rapid defibrillation, basic and advanced medical services, and advanced life support and post-cardiac arrest care. However, some patients may be refractory to these measures. Extracorporeal membrane oxygenation CPR (ECPR), otherwise known as extracorporeal life support, offers an alternative to such refractory cardiac arrest cases. As hospitals have limited resources, it is important to devise effective patient selection methods, and improve our understanding and experience of ECPR to ensure the best outcome. It is also vital to understand that ECPR constitutes only one component of post-cardiac arrest care, which includes other aspects such as therapeutic hypothermia and early perfusion for best patient outcome.
ABSTRACT
Objective To evaluate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on survival and neurological function in adult patients with cardiac arrest.Methods The PubMed and Web of Science were searched to collect relevant literature from Jan 1980 to Nov 2015,and two reviewers strictly distinguished the studies,assessed the quality of studies and picked up the valuable data for statistical analysis by using RevMan 5.0.Results A total of 8 studies involving 27 18 patients were included in our review.Of them,462 patients were treated with ECPR and 2 256 patients were cared with CCPR.The meta analysis showed that the survival discharge rate (OR =2.92,95％ CI:2.24-3.81,P ＜ 0.01),long-term survival rate (OR =2.97,95％ CI:2.11-4.19,P＜0.01) and neurological function status (OR=3.50,95％CI:2.36-5.81,P＜ 0.01) of ECPR (n =182) were better than those of CCPR (n =182).In 4 studies,propensity score matching was used to minimize bias and heterogeneity.The meta analysis also showed that the rate of ROSC,survival discharge rate,long-term survival rate and neurological function status in ECPR were superior over CCPR.Conclusions ECPR would be the excellent measures to improve ROSC rate,survival discharge rate,long-term survival rate and neurological outcome in adult victims with cardiac arrest.