1Department of Medicine, Dankook University Hospital, Dankook University School of Medicine, Cheonan, Korea
2Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
5Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Copyright © 2023 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING
This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (project no. 1711138313, KMDF_PR_20200901_0159).
AUTHOR CONTRIBUTIONS
Conceptualization: YIL, JHY, GYS. Data curation: YIL, REK. Formal analysis: YIL, REK, GYS. Funding acquisition: GYS. Methodology: JHY, CRC, GYS. Project administration: JHY, CRC, GYS. Visualization: YIL, REK. Writing–original draft: YIL, REK, GYS. Writing–review & editing: SJN, JAR, YHC.
Variable | Good neurologic outcome (n=65) | Poor neurologic outcome (n=90) | P-value |
---|---|---|---|
Age (yr) | 57 (47–65) | 67 (52–75) | 0.001 |
Male | 50 (76.9) | 62 (68.9) | 0.270 |
Body mass index (kg/m2) | 24.0 (21.3–27.2) | 24.0 (21.5–26.9) | 0.745 |
Current smoker | 19 (29.2) | 17 (18.9) | 0.142 |
Comorbidity (%) | |||
Diabetes mellitus | 19 (29.2) | 35 (38.9) | 0.213 |
Hypertension | 22 (33.8) | 49 (54.4) | 0.011 |
Malignancy | 8 (12.3) | 11 (12.4) | 0.992 |
Coronary artery disease | 10 (15.4) | 27 (30.0) | 0.035 |
Peripheral arterial occlusive disease | 2 (3.1) | 6 (6.7) | 0.469 |
Stroke | 4 (6.2) | 7 (7.9) | 0.761 |
History of percutaneous coronary intervention | 14 (21.5) | 19 (21.3) | 0.977 |
History of coronary artery bypass graft | 2 (3.1) | 9 (10.0) | 0.121 |
Characteristics of ECPR | |||
Location of ECMO implantation | 0.730 | ||
Intensive care unit | 20 (30.8) | 36 (40.0) | |
Catheterization laboratory | 27 (41.5) | 17 (18.9) | |
Emergency room | 17 (26.2) | 35 (38.9) | |
Operation room | 1 (1.5) | 2 (2.2) | |
Out-of-hospital cardiac arrest | 6 (9.2) | 23 (25.6) | 0.010 |
Initial shockable rhythm | 26 (40.0) | 32 (35.6) | 0.573 |
Defibrillation | 34 (52.3) | 56 (62.2) | 0.217 |
ROSC before ECMO implantation | 30 (46.9) | 35 (38.9) | 0.323 |
CPR to pump-on time (min) | 25.2 (15.0–36.8) | 33.0 (24.0–47.0) | 0.001 |
Initial SOFA scorea) | 14.0 (11.5–16.0) | 15.0 (13.0–17.0) | 0.005 |
Values are presented as median (interquartile range) or number (%).
ECPR: extracorporeal cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; ROSC: return of spontaneous circulation; CPR: cardiopulmonary resuscitation; SOFA: Sequential Organ Failure Assessment.
a)SOFA score was calculated using worst values within 24 hours from ECPR. Cardiovascular variable was calculated as 4 in all cases.
Variable | Good neurologic outcome (n=65) | Poor neurologic outcome (n=90) | P-value |
---|---|---|---|
Age (yr) | 57 (47–65) | 67 (52–75) | 0.001 |
Male | 50 (76.9) | 62 (68.9) | 0.270 |
Body mass index (kg/m2) | 24.0 (21.3–27.2) | 24.0 (21.5–26.9) | 0.745 |
Current smoker | 19 (29.2) | 17 (18.9) | 0.142 |
Comorbidity (%) | |||
Diabetes mellitus | 19 (29.2) | 35 (38.9) | 0.213 |
Hypertension | 22 (33.8) | 49 (54.4) | 0.011 |
Malignancy | 8 (12.3) | 11 (12.4) | 0.992 |
Coronary artery disease | 10 (15.4) | 27 (30.0) | 0.035 |
Peripheral arterial occlusive disease | 2 (3.1) | 6 (6.7) | 0.469 |
Stroke | 4 (6.2) | 7 (7.9) | 0.761 |
History of percutaneous coronary intervention | 14 (21.5) | 19 (21.3) | 0.977 |
History of coronary artery bypass graft | 2 (3.1) | 9 (10.0) | 0.121 |
Characteristics of ECPR | |||
Location of ECMO implantation | 0.730 | ||
Intensive care unit | 20 (30.8) | 36 (40.0) | |
Catheterization laboratory | 27 (41.5) | 17 (18.9) | |
Emergency room | 17 (26.2) | 35 (38.9) | |
Operation room | 1 (1.5) | 2 (2.2) | |
Out-of-hospital cardiac arrest | 6 (9.2) | 23 (25.6) | 0.010 |
Initial shockable rhythm | 26 (40.0) | 32 (35.6) | 0.573 |
Defibrillation | 34 (52.3) | 56 (62.2) | 0.217 |
ROSC before ECMO implantation | 30 (46.9) | 35 (38.9) | 0.323 |
CPR to pump-on time (min) | 25.2 (15.0–36.8) | 33.0 (24.0–47.0) | 0.001 |
Initial SOFA score |
14.0 (11.5–16.0) | 15.0 (13.0–17.0) | 0.005 |
Variable | Good neurologic outcome (n=65) | Poor neurologic outcome (n=90) | P-value |
---|---|---|---|
Post-ECPR management | |||
ECMO duration (hr) | 63.7 (34.6–119.8) | 60.6 (25.0–130.1) | 0.776 |
Targeted temperature management | 14 (21.5) | 19 (21.1) | 0.949 |
Mechanical ventilator | 52 (80.0) | 75(83.3) | 0.595 |
CRRT | 15 (23.1) | 47 (52.2) | <0.001 |
Vasopressor | 62 (95.4) | 82 (91.1) | 0.360 |
Intra-aortic balloon counter pulsation | 6 (9.2) | 6 (6.7) | 0.556 |
Left ventricle venting | 2 (3.1) | 5 (5.6) | 0.700 |
Distal perfusion | 34 (52.3) | 29 (32.2) | 0.012 |
ECMO-related complication | |||
Stroke | 3 (4.6) | 6 (6.7) | 0.735 |
Limb ischemia | 4 (6.2) | 8 (8.9) | 0.530 |
Gastrointestinal bleeding | 1 (1.5) | 9 (10.0) | 0.046 |
ECMO site bleeding | 8 (12.3) | 10 (11.1) | 0.819 |
Variable | Good neurologic outcome (n=65) | Poor neurologic outcome (n=90) | P-value |
---|---|---|---|
Initial tissue hypoxia parameter | |||
RQ | 1.7 (1.1–2.8) | 2.2 (1.5–3.6) | 0.021 |
ΔpCO2 (mm Hg) | 7.0 (4.6–11.8) | 9.7 (5.7–14.8) | 0.093 |
Lactate (mmol/L) | 5.4 (2.8–10.4) | 8.2 (5.1–12.4) | 0.004 |
Clinical outcome | |||
Hospital mortality | 0 | 79 (87.8) | <0.001 |
Hospital length of stay after ECPR (day) | 22.0 (11.5–56.5) | 5.0 (2.0–19.0) | <0.001 |
Cerebral performance category score | 1.0 (1.0–1.0) | 5.0 (4.0–5.0) | <0.001 |
Variable | Univariable |
Multivariable |
||
---|---|---|---|---|
OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value | |
Age (yr) | 1.04 (1.01–1.06) | 0.002 | 1.04 (1.01–1.07) | 0.003 |
Hypertension | 2.34 (1.21–4.52) | 0.012 | 1.83 (0.82–4.09) | 0.141 |
Coronary artery disease | 2.36 (1.05–5.30) | 0.038 | 1.36 (0.53–3.47) | 0.519 |
Out-of-hospital cardiac arrest | 3.38 (1.29–8.85) | 0.013 | 2.99 (0.99–8.99) | 0.052 |
CPR to pump-on time (min) | 1.03 (1.01–1.05) | 0.003 | 1.04 (1.01–1.06) | 0.002 |
Lactate >7.1 (mmol/L) | 3.07 (1.58–5.98) | <0.001 | 2.26 (1.01–5.04) | 0.047 |
RQ ≥1.7 | 2.06 (1.07–3.97) | 0.030 | 1.43 (0.65–3.13) | 0.374 |
Values are presented as median (interquartile range) or number (%). ECPR: extracorporeal cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; ROSC: return of spontaneous circulation; CPR: cardiopulmonary resuscitation; SOFA: Sequential Organ Failure Assessment. SOFA score was calculated using worst values within 24 hours from ECPR. Cardiovascular variable was calculated as 4 in all cases.
Values are presented as median (interquartile range) or number (%). ECPR: extracorporeal cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; CRRT: continuous renal replacement therapy.
Values are presented as median (interquartile range). RQ: respiratory quotient; ΔpCO2: venous-arterial difference in CO2 tension; ECPR: extracorporeal cardiopulmonary resuscitation.
OR: odds ratio; CI: confidence interval; CPR: cardiopulmonary resuscitation; RQ: respiratory quotient.