Advertisement

Early full-body computed tomography in patients after extracorporeal cardiopulmonary resuscitation (eCPR)

  • Viviane Zotzmann
    Correspondence
    Corresponding author at: Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany Hugstetterstrasse 55, 79106 Freiburg, Germany.
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Jonathan Rilinger
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Corinna Nadine Lang
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Daniel Duerschmied
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Christoph Benk
    Affiliations
    Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Christoph Bode
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Tobias Wengenmayer
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Dawid L. Staudacher
    Affiliations
    Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany

    Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author

      Abstract

      Introduction

      Initiation of venoarterial extracorporeal membrane oxygenation (ECMO) under ongoing cardiopulmonary resuscitation (eCPR) in patients with refractory cardiac arrest may improve otherwise deleterious outcome. In general, the duration of mechanical resuscitation from collapse to ECMO ranges from 40 to 70 min. CPR-related injuries are reported frequently in non-eCPR patients. We wanted to quantify CPR-related injuries in eCPR patients.

      Methods

      All eCPR patients cannulated at a tertiary referral medical center between October 2010 and October 2017 were included in a retrospective registry study. A full-body CT scan was performed within the first 24 h after eCPR.

      Results

      A total of 103 patients (mean age 58.8 ± 16.7 years, CPR duration 61.7 ± 31.9 min, and hospital survival 13.6 %) underwent eCPR and immediate full-body computed tomography (CT). Full-body CT detected the cause for collapse in 16.5% of patients. Average number of pathologies detected per CT scan was 6.5 ± 3.3 findings per patient, of which 2.6 ± 1.5 findings were retrospectively considered of clinical relevance for subsequent treatment. Most frequent findings were multiple rib or sternal fractures (65.5%), pneumo- or hemothorax (32.3%) and pulmonary infiltrates (91.3%). Intracranial bleedings and cerebral edema were frequent (10.7% and 26.2%). A total of 20 patients (19.4%) had findings in whole-body CT that were considered to be so severe that further treatment was considered futile and therapy was subsequently discontinued. Most findings were associated with poor outcome with the exception of rib fractures, bleedings and abdominal trauma, which might have been caused by vigorous resuscitation efforts and were associated with favorable outcome.

      Conclusion

      A full-body CT scan performed after eCPR revealed substantial clinically significant findings. Therefore, it might be reasonable to routinely perform a full-body CT in all eCPR patients.

      Abbreviations:

      CPR (cardiopulmonary resuscitation), CT (computed tomography), eCPR (extracorporeal cardiopulmonary resuscitation), IHCA (intra-hospital cardiac arrest), OHCA (out-of-hospital cardiac arrest), ROSC (return of spontaneous circulation), VA-ECMO (veno-arterial extracorporeal membrane oxygenation)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jacobs I.
        • Nadkarni V.
        • Bahr J.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).
        Resuscitation. 2004; 63: 233-249
        • Wang C.-H.
        • Chou N.-K.
        • Becker L.B.
        • et al.
        Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – A comparison with that for extracorporeal rescue for in-hospital cardiac arrest.
        Resuscitation. 2014; 85: 1219-1224
        • Wengenmayer T.
        • Rombach S.
        • Ramshorn F.
        • et al.
        Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR).
        Crit Care. 2017; 21: 157
        • Kuroki N.
        • Abe D.
        • Iwama T.
        • et al.
        Association between delay to coronary reperfusion and outcome in patients with acute coronary syndrome undergoing extracorporeal cardiopulmonary resuscitation.
        Resuscitation. 2017; 114: 1-6
        • Kim S.
        • Kim H.
        • Lee H.
        • Ahn H.
        • Lee S.
        Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis.
        Resuscitation. 2016; 103: 106-116
        • Kashiura M.
        • Sugiyama K.
        • Tanabe T.
        • Akashi A.
        • Hamabe Y.
        Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a retrospective observational study.
        Bmc Anesthesiol. 2017; 17: 4
        • Shin T.
        • Choi J.H.
        • Jo I.
        • et al.
        Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation&ast.
        Crit Care Med. 2011; 39: 1-7
        • Yannopoulos D.
        • Bartos J.A.
        • Raveendran G.
        • et al.
        Coronary Artery Disease in Patients With Out-of-Hospital Refractory Ventricular Fibrillation Cardiac Arrest.
        J Am Coll Cardiol. 2017; 70: 1109-1117
        • Stub D.
        • Bernard S.
        • Pellegrino V.
        • et al.
        Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial).
        Resuscitation. 2015; 86: 88-94
        • Reynolds J.C.
        • Frisch A.
        • Rittenberger J.C.
        • Callaway C.W.
        Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest.
        Circulation. 2013; 128: 2488-2494
        • Koga Y.
        • Fujita M.
        • Yagi T.
        • et al.
        Effects of mechanical chest compression device with a load-distributing band on post-resuscitation injuries identified by post-mortem computed tomography.
        Resuscitation. 2015; 96: 226-231
        • Lardi C.
        • Egger C.
        • Larribau R.
        • Niquille M.
        • Mangin P.
        • Fracasso T.
        Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study.
        Int J Legal Med. 2015; 129: 1035-1042
        • Smekal D.
        • Lindgren E.
        • Sandler H.
        • Johansson J.
        • Rubertsson S.
        CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicentre study of victims after unsuccessful resuscitation.
        Resuscitation. 2014; 85: 1708-1712
        • Montoya J.
        • Stawicki S.
        • Evans D.
        • et al.
        From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment.
        Eur J Trauma Emerg S. 2016; 42: 119-126
        • Huber-Wagner S.
        • Lefering R.
        • Qvick L.M.
        • et al.
        Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.
        Lancet. 2009; 373: 1455-1461
        • Sampson M.A.
        • Colquhoun K.B.M.
        • Hennessy N.L.M.
        Computed tomography whole body imaging in multi-trauma:7 years experience.
        Clin Radiol. 2006; 61: 365-369
        • Nolan J.P.
        • Soar J.
        • Cariou A.
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015 Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.
        Resuscitation. 2015; 95: 202-222
        • Monsieurs K.G.
        • Nolan J.P.
        • Bossaert L.L.
        • et al.
        European Resuscitation Council Guidelines for Resuscitation 2015 Section 1. Executive summary.
        Resuscitation. 2015; 95: 1-80
        • Chelly J.
        • Mongardon N.
        • Dumas F.
        • et al.
        Benefit of an early and systematic imaging procedure after cardiac arrest: Insights from the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) registry.
        Resuscitation. 2012; 83: 1444-1450
        • Dumas F.
        • Bougouin W.
        • Geri G.
        • et al.
        Emergency Percutaneous Coronary Intervention in Post–Cardiac Arrest Patients Without ST-Segment Elevation Pattern Insights From the PROCAT II Registry.
        Jacc Cardiovasc Interventions. 2016; 9: 1011-1018
        • Lahner D.
        • Nikolic A.
        • Marhofer P.
        • et al.
        Incidence of complications in intrahospital transport of critically ill patients – experience in an Austrian university hospital.
        Wien Klin Wochenschr. 2007; 119: 412-416
        • Staudacher D.L.
        • Gold W.
        • Biever P.M.
        • Bode C.
        • Wengenmayer T.
        Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation.
        J Crit Care. 2017; 37: 130-135
        • Lidegran M.
        • Palmér K.
        • Jorulf H.
        • Lindén V.
        CT in the evaluation of patients on ECMO due to acute respiratory failure.
        Pediatr Radiol. 2002; 32: 567-574
        • Lidegran M.K.
        • Mosskin M.
        • Ringertz H.G.
        • Frenckner B.P.
        • Lindén V.B.
        Cranial CT for Diagnosis of Intracranial Complications in Adult and Pediatric Patients During ECMO: Clinical Benefits in Diagnosis and Treatment.
        Acad Radiol. 2007; 14: 62-71
        • Truhlář A.
        • Deakin C.D.
        • Soar J.
        • et al.
        European Resuscitation Council Guidelines for Resuscitation 2015 Section 4. Cardiac arrest in special circumstances.
        Resuscitation. 2015; 95: 148-201
        • Champigneulle B.
        • Haruel P.A.
        • Pirracchio R.
        • et al.
        Major traumatic complications after out-of-hospital cardiac arrest: Insights from the Parisian registry.
        Resuscitation Volume. 2018; 128: 70-75