Skip to main content

Advertisement

SpringerLink
Log in

Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objective

This study aimed to identify predictors of mortality in patients with out-of-hospital cardiac arrest (OHCA) undergoing in-hospital extracorporeal life support system (ECLS) treatment.

Methods

We retrospectively studied the characteristics and clinical outcomes of 28 patients (January 2010 and December 2011) with OHCA and veno-arterial ECLS implemented during ongoing cardiopulmonary resuscitation (CPR) upon admission to the cath lab. Baseline left ventricular ejection fraction (LVEF) was determined after ECLS implantation and then every 24 h during and after successful weaning from ECLS.

Results

Overall 30-day survival rate was 39.3 % (11 of 28 patients). Baseline characteristics, initial laboratory measurements, and LVEF on admission were not significantly different between survivors and non-survivors. There was no difference regarding median CPR duration [survivors 44.0 min (IQR 31.0-45.0) vs. non-survivors 53.0 min (IQR 40.0-61.3); P = 0.23]. Door-to-ECLS implantation time was significantly longer in non-survivors [42.5 min (IQR 28.0–56.5) vs. 25.0 min (IQR 21.0–30.0); P < 0.01]. ECLS treatment duration was not significantly different between the two groups [survivors: 4.0 days (IQR 1.5–7.5) vs. non-survivors 6.5 days (IQR 1.0–8.0); P = 0.69]. LVEF significantly improved in survivors during ECLS treatment (mean ± SD survivor 47.5 ± 14.7 % vs. non-survivor 23.3 ± 14.9 %; P < 0.01). The door-to-ECLS implantation time was the only significant and independent predictor of 30-day mortality in multivariate Cox regression analysis (P = 0.04). Kaplan–Meier survival analysis showed a benefit favouring patients with a door-to-ECLS implantation time <30 min (log rank 6.29; P = 0.01).

Conclusion

A door-to-ECLS implantation time <30 min significantly improves 30-day outcomes in patients with OHCA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nolan JP, Hazinski MF, Billi JE, Boettiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O’Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D (2010) Part 1: Executive summary: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 81(Suppl 1):e1–e25. doi:10.1016/j.resuscitation.2010.08.002

    Article  PubMed  Google Scholar 

  2. Mollmann H, Szardien S, Liebetrau C, Elsasser A, Rixe J, Rolf A, Nef H, Weber M, Hamm C (2011) Clinical outcome of patients treated with an early invasive strategy after out-of-hospital cardiac arrest. J Int Med Res 39(6):2169–2177

    Article  PubMed  CAS  Google Scholar 

  3. Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF (2010) Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122(18 Suppl 3):S720–S728. doi:10.1161/CIRCULATIONAHA.110.970970

    Article  PubMed  Google Scholar 

  4. Ferrari M, Hekmat K, Jung C, Ferrari-Kuehne K, Pfeifer R, Schlosser MH, Werner GS, Figulla HR (2011) Better outcome after cardiopulmonary resuscitation using percutaneous emergency circulatory support in non-coronary patients compared to those with myocardial infarction. Acute Cardiac Care 13(1):30–34. doi:10.3109/17482941.2010.542466

    Article  PubMed  Google Scholar 

  5. Overlie PA, Walter PD, Hurd HP 2nd, Wells GA, Seger JJ, Zias J, Wey RJ, Jensen JB, Shoukfeh MF, Levine MJ et al (1994) Emergency cardiopulmonary support with circulatory support devices. Cardiology 84(3):231–237

    Article  PubMed  CAS  Google Scholar 

  6. Basic D, Mollmann H, Haas MA, Rolf A, Jovanovic A, Liebetrau C, Szardien S, Leick J, Dorr O, Skwara A, Walther T, Hamm CW, Nef HM (2012) A TASH experience: post-infarction myocardial oedema necessitating the support of ECMO and occurrence of significant mitral regurgitation. Clin Res Cardiol: Off J German Cardiac Soc 101(2):149–153. doi:10.1007/s00392-011-0396-y

    Article  CAS  Google Scholar 

  7. Leick J, Liebetrau C, Szardien S, Willmer M, Rixe J, Nef H, Rolf A, Hamm C, Mollmann H (2012) Percutaneous circulatory support in a patient with cardiac arrest due to acute pulmonary embolism. Clin Res Cardiol: Off J German Cardiac Soc 101(12):1017–1020. doi:10.1007/s00392-012-0481-x

    Article  Google Scholar 

  8. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372(9638):554–561. doi:10.1016/S0140-6736(08)60958-7

    Article  PubMed  Google Scholar 

  9. Morimura N, Sakamoto T, Nagao K, Asai Y, Yokota H, Tahara Y, Atsumi T, Nara S, Hase M (2011) Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a review of the Japanese literature. Resuscitation 82(1):10–14. doi:10.1016/j.resuscitation.2010.08.032

    Article  PubMed  Google Scholar 

  10. Avalli L, Maggioni E, Formica F, Redaelli G, Migliari M, Scanziani M, Celotti S, Coppo A, Caruso R, Ristagno G, Fumagalli R (2012) Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience. Resuscitation 83(5):579–583. doi:10.1016/j.resuscitation.2011.10.013

    Article  PubMed  Google Scholar 

  11. Chen YS, Yu HY, Huang SC, Lin JW, Chi NH, Wang CH, Wang SS, Lin FY, Ko WJ (2008) Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation. Crit Care Med 36(9):2529–2535. doi:10.1097/CCM.0b013e318183f491

    Article  PubMed  Google Scholar 

  12. Garot P, Lefevre T, Eltchaninoff H, Morice MC, Tamion F, Abry B, Lesault PF, Le Tarnec JY, Pouges C, Margenet A, Monchi M, Laurent I, Dumas P, Garot J, Louvard Y (2007) Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation 115(11):1354–1362. doi:10.1161/CIRCULATIONAHA.106.657619

    Article  PubMed  Google Scholar 

  13. Kagawa E, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S, Nakama Y, Dai K, Takayuki O, Ikenaga H, Morimoto Y, Ejiri K, Oda N (2010) Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation 81(8):968–973. doi:10.1016/j.resuscitation.2010.03.037

    Article  PubMed  Google Scholar 

  14. Thiagarajan RR, Brogan TV, Scheurer MA, Laussen PC, Rycus PT, Bratton SL (2009) Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in adults. Ann Thorac Surg 87(3):778–785. doi:10.1016/j.athoracsur.2008.12.079

    Article  PubMed  Google Scholar 

  15. Le Guen M, Nicolas-Robin A, Carreira S, Raux M, Leprince P, Riou B, Langeron O (2011) Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care 15(1):R29. doi:10.1186/cc9976

    Article  PubMed  Google Scholar 

  16. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Bohm M, Ebelt H, Schneider S, Schuler G, Werdan K, Investigators I-SIT (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. New Engl J Med 367(14):1287–1296. doi:10.1056/NEJMoa1208410

    Article  PubMed  CAS  Google Scholar 

  17. Kim JY, Shin SD, Ro YS, Song KJ, Lee EJ, Park CB, Hwang SS, For the CardioVascular Disease Surveillance investigators (2013) Post-resuscitation care and outcomes of out-of-hospital cardiac arrest: A nationwide propensity score-matching analysis. Resuscitation. doi:10.1016/j.resuscitation.2013.02.010

    Google Scholar 

  18. Rana OR, Schroder JW, Kuhnen JS, Saygili E, Gemein C, Zink MD, Schauerte P, Schiefer J, Schwinger RH, Weis J, Marx N, Kelm M, Meyer C, Saygili E (2012) The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study. Clin Res Cardiol: Off J German Cardiac Soc 101(7):533–543. doi:10.1007/s00392-012-0423-7

    Article  Google Scholar 

  19. Sakamoto S, Taniguchi N, Nakajima S, Takahashi A (2012) Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome. Ann Thorac Surg 94(1):1–7. doi:10.1016/j.athoracsur.2012.01.032

    Article  PubMed  Google Scholar 

  20. SOS-KANTO study group (2007) Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 369(9565):920–926. doi:10.1016/S0140-6736(07)60451-6

    Article  Google Scholar 

  21. Abanador-Kamper N, Kamper L, Wolfertz J, Dinh W, Thurmann P, Seyfarth M (2012) Influence of algorithm-based analgesia and sedation in patients after sudden cardiac arrest. Clin Res Cardiol: Off J German Cardiac Soc 101(3):175–183. doi:10.1007/s00392-011-0378-0

    Article  CAS  Google Scholar 

  22. Koester R, Kaehler J, Barmeyer A, Mullerleile K, Priefler M, Soeffker G, Braune S, Nierhaus A, Meinertz T, Kluge S (2011) Coronary angiography and intervention during hypothermia can be performed safely without cardiac arrhythmia or vasospasm. Clin Res Cardiol: Off J German Cardiac Soc 100(11):1013–1019. doi:10.1007/s00392-011-0334-z

    Article  Google Scholar 

  23. Jaski BE, Ortiz B, Alla KR, Smith SC Jr, Glaser D, Walsh C, Chillcott S, Stahovich M, Adamson R, Dembitsky W (2010) A 20-year experience with urgent percutaneous cardiopulmonary bypass for salvage of potential survivors of refractory cardiovascular collapse. J Thorac Cardiovasc Surg 139(3):753–757 e751–e752. doi:10.1016/j.jtcvs.2009.11.018

    Article  PubMed  Google Scholar 

  24. Belle L, Mangin L, Bonnet H, Fol S, Santre C, Delavenat L, Savary D, Bougon D, Vialle E, Dompnier A, Desjoyaux E, Blin D (2012) Emergency extracorporeal membrane oxygenation in a hospital without on-site cardiac surgical facilities. EuroInterv: J EuroPCR Collab Work Group Interv Cardiol Eur Soc Cardiol 8(3):375–382. doi:10.4244/EIJV8I3A57

    Google Scholar 

  25. Beurtheret S, Mordant P, Paoletti X, Marijon E, Celermajer DS, Leger P, Pavie A, Combes A, Leprince P (2013) Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program). Eur Heart J 34(2):112–120. doi:10.1093/eurheartj/ehs081

    Article  PubMed  Google Scholar 

  26. Loforte A, Montalto A, Ranocchi F, Della Monica PL, Casali G, Lappa A, Menichetti A, Contento C, Musumeci F (2012) Peripheral extracorporeal membrane oxygenation system as salvage treatment of patients with refractory cardiogenic shock: preliminary outcome evaluation. Artif Organs 36(3):E53–E61. doi:10.1111/j.1525-1594.2011.01423.x

    Article  PubMed  CAS  Google Scholar 

  27. Skrifvars MB, Varghese B, Parr MJ (2012) Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation 83(6):728–733. doi:10.1016/j.resuscitation.2011.11.036

    Article  PubMed  CAS  Google Scholar 

  28. Haneya A, Philipp A, Diez C, Schopka S, Bein T, Zimmermann M, Lubnow M, Luchner A, Agha A, Hilker M, Hirt S, Schmid C, Muller T (2012) A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest. Resuscitation 83(11):1331–1337. doi:10.1016/j.resuscitation.2012.07.009

    Article  PubMed  Google Scholar 

  29. Belohlavek J, Mlcek M, Huptych M, Svoboda T, Havranek S, Ost’adal P, Boucek T, Kovarnik T, Mlejnsky F, Mrazek V, Belohlavek M, Aschermann M, Linhart A, Kittnar O (2012) Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation. Crit Care 16(2):R50. doi:10.1186/cc11254

    Article  PubMed  Google Scholar 

  30. Reynolds JC, Salcido DD, Menegazzi JJ (2010) Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest. Prehospital Emerg Care: Off J National Assoc EMS Phys Nat Assoc State EMS Dir 14(1):78–84. doi:10.3109/10903120903349796

    Article  Google Scholar 

  31. Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold M, Nowak RM (1990) Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA J Am Med Assoc 263(8):1106–1113

    Article  CAS  Google Scholar 

  32. Beckmann A, Benk C, Beyersdorf F, Haimerl G, Merkle F, Mestres C, Pepper J, Wahba A (2011) Position article for the use of extracorporeal life support in adult patients. Eur J Cardio-Thorac surgery : Off J Eur Assoc Cardio-Thorac Surg 40(3):676–680. doi:10.1016/j.ejcts.2011.05.011

    Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Jürgen Leick, Christoph Liebetrau, Sebastian Szardien, Ulrich Fischer-Rasokat, Matthias Willmer, Holger Nef, Andreas Rolf, Christian Hamm & Helge Möllmann

  2. Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Giessen, Germany

    Christoph Liebetrau, Holger Nef, Andreas Rolf, Christian Hamm & Helge Möllmann

  3. Department of Anesthesiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany

    Matthias Arlt

  4. Department of Cardiac Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany

    Arnaud van Linden, Johannes Blumenstein & Thomas Walther

Authors
  1. Jürgen Leick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Liebetrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sebastian Szardien
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrich Fischer-Rasokat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias Willmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arnaud van Linden
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Johannes Blumenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Holger Nef
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andreas Rolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matthias Arlt
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas Walther
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Christian Hamm
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Helge Möllmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helge Möllmann.

Additional information

J. Leick and C. Liebetrau contributed equally.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leick, J., Liebetrau, C., Szardien, S. et al. Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol 102, 661–669 (2013). https://doi.org/10.1007/s00392-013-0580-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-013-0580-3

Keywords

Search

Navigation