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
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Article info
Publication history
Published online: December 04, 2019
Accepted:
November 27,
2019
Received in revised form:
November 19,
2019
Received:
August 5,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Elsevier B.V. All rights reserved.
