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Acute lung injury and recovery in patients with refractory VT/VF cardiac arrest treated with prolonged CPR and veno-arterial extracorporeal membrane oxygenation

  • Alejandra Gutierrez
    Correspondence
    Corresponding author at: Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, United States.
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States

    Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
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  • Rajat Kalra
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States

    Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
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  • Andrea M. Elliott
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States

    Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
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  • Alexandra Marquez
    Affiliations
    Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States

    Pediatric Cardiology Critical Care, Children’s Hospital, University of Minnesota, United States
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  • Demetris Yannopoulos
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States

    Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
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  • Jason A. Bartos
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States

    Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
    Search for articles by this author

      Abstract

      Aim

      Describe the lung injury patterns among patients presenting with refractory ventricular tachycardia/ventricular fibrillation out-of-hospital cardiac arrest (VT/VF OHCA) supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) facilitated resuscitation.

      Methods

      In this retrospective single-center cohort study including VT/VF OHCA patients supported with VA ECMO, we compared OHCA characteristics, post-arrest computed tomography (CT) scans, ventilator parameters, and other lung-related pathology between survivors, patients who developed brain death, and those with other causes of death.

      Results

      Among 138 patients, 48/138 (34.8%) survived, 31/138 (22.4%) developed brain death, and 59/138 (42.7%) died of other causes. Successful extubation was achieved in 39/138 (28%) with a median time to extubation of 8.0 days (6.0, 11.0) in those who survived. Tracheostomy was required in 15/48 (31.3%) survivors. Chest CT obtained on all patients showed lung injury in at least one lung area in 124/135 (91.8%) patients, predominantly in the dependent posterior areas. There was no association between the number of affected areas and survival. Lung compliance was low on admission [26 (19,33) ml/cmH20], improved throughout hospitalization (p = 0.03), and recovered faster in survivors compared to those who died (p < 0.001). VA-ECMO allowed the use of lung-protective ventilation while maintaining normalized PaO2 and PaCO2. Patients treated with V-A ECMO and either IABP or Impella had lower pulmonary compliance and more affected areas on their CT compared to those treated with V-A ECMO alone.

      Conclusions

      Lung injury is common among patients with refractory VT/VF OHCA requiring V-A ECMO, but imaging severity is not associated with survival. Reductions in lung compliance accompany post-arrest lung injury while compliance recovery is associated with survival.

      Keywords

      Abbreviations:

      OHCA (Out-of Hospital Cardiac Arrest), CPR (Cardiopulmonary resuscitation), LV (Left Ventricle), V-A ECMO (Veno-arterial Extracorporeal Membrane Oxygenator), ECPR (Extracorporeal cardiopulmonary resuscitation), ROSC (Return of Spontaneous Circulation), VT/VF (ventricular tachycardia or ventricular fibrillation), CAD (Coronary artery disease), PCI (percutaneous coronary intervention), IABP (intra-aortic balloon pump), PEEP (Positive end expiratory pressure), CT (Computed tomography)
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