Prehospital ECPR for Out-Of-Hospital Cardiac Arrest.

This article discusses the role of prehospital extracorporeal CPR (ECPR) in improving survival in out-of-hospital cardiac arrest (OHCA). The Sydney PRECARE feasibility trial is discussed, highlighting the need for intensive interprofessional training and engagement when establishing a prehospital ECPR programme. The role of emergency physicians in the future of cardiac arrest care is also explored.

Cardioprotection by poloxamer 188 is mediated through increased endothelial nitric oxide production.

Ischemia/reperfusion (I/R) injury significantly contributes to the morbidity and mortality associated with cardiac events. Poloxamer 188 (P188), a non-ionic triblock copolymer, has been proposed to mitigate I/R injury by stabilizing cell membranes. However, the underlying mechanisms remain incompletely understood, particularly concerning endothelial cell (EC) function and nitric oxide (NO) production.

Associations with resolution of ST-segment elevation myocardial infarction criteria on out-of-hospital 12-lead electrocardiograms following resuscitation from cardiac arrest.

Introduction: A previous study found that following out-of-hospital cardiac arrest (OHCA), 67% of out-of-hospital 12-lead electrocardiograms (ECGs) diagnostic for ST-segment elevation myocardial infarction (STEMI) changed to non-STEMI on repeat emergency department (ED) ECG. Here we evaluated associations with resolution of STEMI on ED ECG.

Methods: In this secondary analysis of a previous retrospective study, adults (≥18 years) with return of spontaneous circulation (ROSC) following OHCA, at least 1 out-of-hospital and ED ECG and transport to the study hospital were entered.

International Consensus on Evidence Gaps and Research Opportunities in Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: A Report From the National Heart, Lung, and Blood Institute Workshop.

The increased accessibility of extracorporeal membrane oxygenation following the COVID-19 pandemic and the publication of the first randomized trial of extracorporeal cardiopulmonary resuscitation (ECPR) prompted the National Heart, Lung, and Blood Institute to sponsor a workshop on ECPR. Two more randomized trials have since been published in 2022 and 2023. Based on the combined findings and review of the evidence, an international panel of authors identified gaps in science, inequities in care and diversity in outcomes, and suggested research opportunities and next steps.

Effect of chest compressions in addition to extracorporeal life support on carotid flow in an experimental model of refractory cardiac arrest in pigs.

Background: Extracorporeal life support (ECLS) provides organ perfusion in refractory cardiac arrest but during the initiation of ECLS mean arterial pressure (MAP) and carotid flow may be suboptimal due to hypotension and/or insufficient flow. We hypothesized that cardiopulmonary resuscitation (CPR) in addition to ECLS may increase carotid flow and MAP compared to ECLS alone.

Methods: Observational pilot study comparing hemodynamic parameters before and after CPR cessation in pigs supported by ECLS for experimental refractory cardiac arrest.

Left ventricular energetics in patients receiving veno-arterial extracorporeal membrane oxygenation for extracorporeal cardiopulmonary resuscitation.

Introduction: The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underwent treatment with an intensive care strategy involving extracorporeal cardiopulmonary resuscitation (ECPR).

Methods: We conducted invasive haemodynamic assessments on 15 patients who underwent ECPR and achieved return of spontaneous circulation.

Mild (34 °C) versus moderate hypothermia (24 °C) in a swine model of extracorporeal cardiopulmonary resuscitation.

Background: The role of hypothermia in post-arrest neuroprotection is controversial. Animal studies suggest potential benefits with lower temperatures, but high-fidelity ECPR models evaluating temperatures below 30 °C are lacking.

Objectives: To determine whether rapid cooling to 24 °C initiated upon reperfusion reduces brain injury compared to 34 °C in a swine model of ECPR.

Temporal trends in organ donation among cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation.

Aims: This study explores the evolution of organ donation from patients treated with extracorporeal-cardiopulmonary-resuscitation (ECPR) for refractory out-of-hospital-cardiac-arrest (OHCA) and evaluates the public health benefits of a mature ECPR program.

Methods: This retrospective, single-center study included OHCA patients (2016-2023) who had mostly initial shockable rhythms and were treated with ECPR. Organ donation rates from non-survivors through these years were analyzed.

Bleeding and Thrombosis in Patients With Out-of-Hospital Ventricular Tachycardia/Ventricular Fibrillation Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation.

Background: Extracorporeal cardiopulmonary resuscitation improves outcomes after out-of-hospital cardiac arrest. However, bleeding and thrombosis are common complications. We aimed to describe the incidence and predictors of bleeding and thrombosis and their association with in-hospital mortality.

Evolution of distal limb perfusion management in adult peripheral venoarterial extracorporeal membrane oxygenation with femoral artery cannulation.

Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications.

The cerebral and cardiac effects of Norepinephrine in an experimental cardiac arrest model.

Introduction: Epinephrine has been the main drug recommended for decades during cardiopulmonary resuscitation (CPR). But epinephrine's ß-adrenergic effects might increase myocardial oxygen consumption and may cause arrythmias after ROSC. Norepinephrine has a weaker ß-adrenergic effect and could be useful during CPR.

Machine Learning Identifies Higher Survival Profile In Extracorporeal Cardiopulmonary Resuscitation.

Objectives: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival in patients with refractory out-of-hospital cardiac arrest (OHCA) caused by shockable rhythms. Further refinement of patient selection is needed to focus this resource-intensive therapy on those patients likely to benefit. This study sought to create a selection model using machine learning (ML) tools for refractory cardiac arrest patients undergoing ECPR.

Virtual reality to predict paravalvular leak in bicuspid severe aortic valve stenosis in transcatheter aortic valve implants.

Objectives: Severe aortic stenosis (AS) in bicuspid aortic valves (BAV) is associated with an increased risk of paravalvular leak (PVL) after a transcatheter aortic valve replacement (TAVR). Virtual reality (VR) has been shown to be an effective tool in surgical training, but its utility in clinical practice has not been studied. Here we present the first study to evaluate the use of VR simulation in pre-procedure planning and prediction of PVL in TAVR in patients with severe BAV AS.

Left ventricular hemodynamics with veno-arterial extracorporeal membrane oxygenation.

Background: There is considerable debate about the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Aims: To evaluate the changes in left ventricular (LV) function, volumes, and work in patients treated with VA-ECMO using invasive LV catheterization and three-dimensional echocardiographic volumes.

Methods: Patients on VA-ECMO underwent invasive hemodynamic evaluation due to concerns regarding candidacy for decannulation.

Wolf Creek XVII Part 7: Mechanical circulatory support.

Introduction: Failure to restore spontaneous circulation remains a major cause of death for cardiac arrest (CA) patients. Mechanical circulatory support, specifically extracorporeal cardiopulmonary resuscitation (ECPR), has emerged as a feasible and efficacious rescue strategy for selected refractory CA patients.

Methods: Mechanical Circulatory Support was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA.

Case Report: Correlation between pulmonary capillary wedge pressure and left-ventricular diastolic pressure during treatment with veno-arterial extracorporeal membrane oxygenation.

Background: Pulmonary capillary wedge pressure (PCWP) is often used as a surrogate for left-ventricular end-diastolic pressure in patients (LVEDP) who are on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support for cardiogenic shock and cardiac arrest. However, the correlation between PCWP and LVEDP is not clear in the setting of V-A ECMO usage. We sought to evaluate this correlation in this case series.

Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established.

Methods: We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA.

Impact of age on survival for patients receiving ECPR for refractory out-of-hospital VT/VF cardiac arrest.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival for patients with refractory ventricular tachycardia (VT)/ventricular fibrillation (VF) out-of-hospital cardiac arrest. Prior studies of the impact of age on outcomes in ECPR have demonstrated mixed results and we aim to investigate this relationship.

Methods: Patients treated with ECPR at the University of Minnesota Medical Center for refractory out-of-hospital VT/VF arrest from December 2015 to February 2023 were included.