Study suggests new role for ECMO in treating patients with cardiac arrest and profound shock

May 17, 2013

Extracorporeal membrane oxygenation (ECMO), a procedure traditionally used during cardiac surgeries and in the ICU that functions as an artificial replacement for a patient's heart and lungs, has also been used to resuscitate cardiac arrest victims in Japan, Taiwan, and South Korea. Now, a novel study of this technique in the U.S. has been completed by researchers at the Perelman School of Medicine at the University of Pennsylvania, indicating a potential role for this intervention to save patients who are unable to be resuscitated through conventional measures. The new findings will be presented at the Society for Academic Emergency Medicine annual meeting in Atlanta, Ga.

ECMO directly oxygenates and removes carbon dioxide from the blood, and is conventionally used for both respiratory and . The procedure requires 24/7 monitoring and care for the duration of the treatment, but provides a critical back-up for patients whose heart and lungs are so severely diseased or damaged that they can no longer function.

"Over the last decade, we have made great strides in the field of cardiac resuscitation science, including the development of novel methods of therapeutic hypothermia and the use of cardiac bypass following cardiac arrest," said lead study author David Gaieski, MD, an associate professor of in the Perelman School of Medicine and clinical director of Penn's Center for Resuscitation Science. "Yet cardiac arrests still take the lives of more than 300,000 Americans each year, and we are continuing to explore how to use new and expanded strategies to help save these patients. Based on the work of our colleagues in Asia, we sought to report our own experience using ECMO for a select set of patients with refractory cardiac arrest and profound shock."

For the study, the research team used a between clinicians in the Department of Emergency Medicine and surgeons within the Division of Cardiovascular Surgery at Penn to assess the outcomes for select patients undergoing ECMO presenting in the emergency department (ED) and for in-hospital cardiac arrests at the Hospital of the University of Pennsylvania.

They studied the approach in patients who otherwise would have died – who were unable to be resuscitated through CPR and defibrillation and who would not have been eligible for other post-arrest therapies such as therapeutic hypothermia.

Inclusion criteria for ED patients included witnessed arrest, bystander CPR, and an initial shockable rhythm. For in-patient arrests, inclusion criteria included presumed cardiac etiology of arrest or refractory shock unresponsive to conventional interventions. Main variables were whether a patient was in cardiac arrest or profound shock and location of patient at time of initiation of ECMO, with the primary outcome of survival to hospital discharge.

Thirty-three patients were included in the study. Of these patients, the mean age was 50 years and 70 percent were men. Three-quarters of the patients were treated for cardiac arrest, and the remainder were treated for refractory shock. Using the ECMO strategy, 21 percent of the patients survived to discharge and five were neurologically intact.

"This preliminary study shows that using ECMO in a collaborative model between emergency physicians and cardiothoracic surgeons can be a useful rescue tool in select cardiac arrest and shock patients. The results are promising given that among patients that regain a pulse after cardiac arrest, only one out of three survive to hospital discharge," said senior study author Michael Acker, MD, chief, Division of Cardiovascular Surgery at Penn Medicine.

The authors note that because ECMO is a resource-intense technology which requires procedural and management expertise, additional research is needed to refine the technique and select the patients that would benefit most from this intervention. Next, the authors hope to study the use of ECMO in conjunction with therapeutic hypothermia to improve neurological outcomes among survivors of .

Explore further: Shock teams and ECMO save lives in massive STEMI

Related Stories

Shock teams and ECMO save lives in massive STEMI

March 11, 2013
The use of extracorporeal membrane oxygenation (ECMO), accompanied by mechanical CPR, in patients with massive myocardial infarctions can lead to unexpected survival. These study findings are being presented March 9 at the ...

Study finds survival from cardiac arrest highest in the operating room or post-anesthesia care unit

May 1, 2013
A University of Michigan study from the "Online First" edition of Anesthesiology found cardiac arrest was associated with improved survival when it occurred in the operating room (O.R.) or post-anesthesia care unit (PACU) ...

Changes needed to improve in-hospital cardiac arrest care, survival

March 11, 2013
Policy and practice changes by healthcare institutions, providers and others could greatly improve medical care and improve survival for people who have a sudden cardiac arrest in the hospital, according to an American Heart ...

200,000 patients treated for cardiac arrest annually in US hospitals, study shows

June 24, 2011
More than 200,000 people are treated for cardiac arrest in United States hospitals each year, a rate that may be on the rise. The findings are reported online this week in Critical Care Medicine in a University of Pennsylvania ...

Beaumont doctors call for training to reduce sudden cardiac arrest fatalities in schools

March 28, 2013
One of the leading causes of death in the United States is sudden cardiac arrest, which claims the lives of more than 325,000 people each year. In a study published in the April issue of the journal Resuscitation, Beaumont ...

Guidelines-based CPR saves more non-shockable cardiac arrest victims

April 2, 2012
People who have a cardiac arrest that can't be helped by a defibrillator shock are more likely to survive if given CPR based on updated guidelines that emphasize chest compressions, according to research reported in the American ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.