Controlled automated reperfusion of the whole body after cardiac arrest: Device profile of the CARL system DOI Creative Commons
Christopher Gaisendrees,

M. Vollmer,

Georg Schlachtenberger

et al.

Artificial Organs, Journal Year: 2024, Volume and Issue: 48(12), P. 1384 - 1391

Published: Aug. 23, 2024

Abstract Background Cardiac arrest is associated with high mortality rates and severe neurological impairments. One of the underlying mechanisms global ischemia‐reperfusion injury body, particularly brain. Strategies to mitigate this may thus improve favorable outcomes. The use extracorporeal cardiopulmonary membrane oxygenation (ECMO) during CA has been shown survival, but available systems are vastly unable deliver goal‐oriented resuscitation control patient's individual physical chemical needs reperfusion. Recently, controlled automated reperfusion whoLe body (CARL), a pulsatile ECMO arterial blood‐gas analysis, introduced goal‐directed therapy post‐arrest phase. Methods This review focuses on device profile CARL. Specifically, we reviewed published literature summarize data regarding its technical features potential benefits in ECPR. Results Peri‐arrest, mitigating IRI ECMO, might be next step toward augmenting survival recovery. To end, CARL promising that improves early phase after resuscitation.

Language: Английский

Extracorporeal Cardiopulmonary Resuscitation: Outcomes Improve With Center Experience DOI Creative Commons
Ingrid Anna Maria Magnet, Wilhelm Behringer, Felix Eibensteiner

et al.

Annals of Emergency Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Extracorporeal cardiopulmonary resuscitation (eCPR) is a rescue therapy for selected patients when conventional (CPR) fails. Current evidence suggests that the success of eCPR depends on well-structured in- and out-of-hospital protocols. This article describes Vienna program, interventions implemented to improve clinical processes patient outcomes. In this retrospective study, we report all with inhospital cardiac arrest treated at our department between 2020 2023. During period, program was restructured, including introduction algorithms interprofessional training. The primary endpoint survival favorable neurologic outcomes 6 months, defined as cerebral performance category score 1 or 2. Overall, 192 were eCPR. proportion 25% (n=48), increasing each year: 15% (5/34) in 2020, 19% (8/42) 2021, 23% (12/53) 2022, 37% (23/63) particularly true patients: 7% (2/29), 14% (4/29), 17% (7/41), 32% (16/50), respectively. Simultaneously, rates witnessed arrest, bystander CPR, initial shockable rhythm increased, whereas low-flow durations decreased. After restructuring able after improvement accompanied increased case volumes, rhythm, decreased durations. learning curve observed illustrates can experience, summation effect training, selection, process standardization.

Language: Английский

Citations

1
The Heart Team Approach to Cardiac Arrest DOI Creative Commons
Tharusan Thevathasan,

Janine Pöss,

Andrea Montisci

et al.

European Heart Journal Supplements, Journal Year: 2025, Volume and Issue: 27(Supplement_4), P. iv31 - iv38

Published: Feb. 4, 2025

Abstract Cardiac arrest is a critical emergency in cardiovascular medicine, requiring rapid, multidisciplinary interventions to enhance patient survival and neurological outcomes. This review explores the unique challenges of managing out-of-hospital (OHCA) in-hospital cardiac (IHCA), with focus on mechanical circulatory support (MCS) extracorporeal cardiopulmonary resuscitation for selected patients. While OHCA management should prioritize rapid transport specialized centres, IHCA may allow immediate, patient-tailored interventions. Post-cardiac syndrome adds complexity, often nuanced MCS escalation weaning. Standardized protocols, ethical considerations, further research are essential refine selection improve outcomes, ultimately advancing care.

Language: Английский

Citations

0
VA-ECMO-assistierte Reanimation beim refraktären Herz-Kreislauf-Stillstand DOI

Marvin Kriz,

Benedikt Schrage

DMW - Deutsche Medizinische Wochenschrift, Journal Year: 2025, Volume and Issue: 150(06), P. 280 - 285

Published: Feb. 21, 2025

Extracorporeal cardiopulmonary resuscitation (ECPR) is an invasive medical intervention using mechanical circulatory support for treating cardiac arrest beyond the limits of conventional (CCPR). ECPR uses veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to maintain organ perfusion while reversible causes arrest. Commonly applied criteria select suitable patients include witnessed arrest, early bystander CPR, and a time frame less than 60 minutes from collapse initiation.A meta-analysis by Low et al. (2023), which included 11 studies with 4,595 4,597 CCPR patients, demonstrated that was not only associated higher survival rates, but also better long-term neurological outcomes. Additionally, number procedures per center linked reduced mortality rates. A 2024 updated confirmed these findings further significantly in-hospital in out-of-hospital (OHCA).Further insights on this topic can be gained individual treatment OHCA: In general, there are several different modalities how deployed, ranging implantation at site index event vs. hospital, even place hospital varies. However, it seems actual pathway VA-ECMO implanted lower importance, highly depends local infrastructure given (rural area municipal area), achieving lowest possible low-flow should primary goal.The available data shows that, despite all advances, still high-risk very demanding personnel requires abundance resources.Overall, promising therapy OHCA improve good outcome, if structured standardized way, carefully selected patients.

Language: Английский

Citations

0
Mechanisms and strategies for organ recovery DOI
David Andrijević, Ana Spajic, Irbaz Hameed

et al.

Nature Reviews Bioengineering, Journal Year: 2025, Volume and Issue: unknown

Published: March 20, 2025

Language: Английский

Citations

0
Neurological outcome predictors after extracorporeal cardiopulmonary resuscitation: a systematic review DOI Creative Commons
Dawid Woszczyk, Wiktoria Zasada, Hanna Cholerzyńska

et al.

Systematic Reviews, Journal Year: 2025, Volume and Issue: 14(1)

Published: March 22, 2025

To consolidate current evidence on predictors of neurological outcome following extracorporeal cardiopulmonary resuscitation (eCPR) in patients with cardiac arrest. We conducted a systematic review the literature across databases including PubMed, MEDLINE, Embase, CINAHL, Cochrane Library, and Web Science. Studies assessing outcomes post-eCPR were identified, total 10 studies eligible for individual assessment which 8 comprising 4353 allowed to perform collective statistical analysis. Favorable associated age < 65 years (OR = 6.17), shockable rhythm at membrane oxygenation initiation 6.67) or hospital arrival 3.68), initial pH ≥ 7.0 2.01). Other factors involved presence any life sign (gasping, positive pupillary light reaction, increased level consciousness before throughout resuscitation) 9.63; Se 0.89, Sp 0.46, PPV 0.22, NPV 0.96), transient return spontaneous circulation, non-hypoxic mechanism occurred hepatitis, public location, hypothermic etiology arrest; however, each those findings was supported by only one study. Unfavorable linked hypoxic brain injury computed tomography 12.40; 0.366, 0.955, 0.767, 0.787) elevated serum creatinine 2.22). The TiPS65 scale showed high predictive accuracy two when cut-off point set 4 points (88.4% 88.6%; 0.172, 0.971, 0.423, 0.906, 0.193, 0.985, 0.646, 0.896, respectively). Some predictors, like call-to-hospital time bystander resuscitation, had mixed results studies. Neurological prognostication eCPR is complex problem requiring consideration multiple variables regarding patient's arrest characteristics. Future research should focus determination outcome-affecting their applicability clinical settings. New knowledge this ground will help create recommendations termination, consequently contributing treatment improvement. PROSPERO CRD42024530305.

Language: Английский

Citations

0
Reasons for death in patients receiving ECPR for refractory out-of-hospital cardiac arrest DOI

Klaudia Farkasovska,

Daniel Rob,

Marie Dacev

et al.

Resuscitation, Journal Year: 2025, Volume and Issue: unknown, P. 110615 - 110615

Published: April 1, 2025

Language: Английский

Citations

0
Impact of Prehospital Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest on Survival with Good Neurological Function: A Systematic Review and Meta-Analysis DOI Creative Commons

Lawrence Leroux,

Nathaniel B. Dennis-Benford,

Amy Bergeron

et al.

Resuscitation Plus, Journal Year: 2025, Volume and Issue: unknown, P. 100974 - 100974

Published: May 1, 2025

Language: Английский

Citations

0
Extrakorporale kardiopulmonale Reanimation (ECPR) – die Zukunft? DOI

Adrian Springer,

Michael Stöck,

Stephan Willems

et al.

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Journal Year: 2024, Volume and Issue: 59(04), P. 226 - 235

Published: April 1, 2024

In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances in traditional measures, out-of-hospital cardiac arrest (OHCA) mortality remains high. the context of cardiopulmonary (ECPR), VA-ECMO therapy offers a promising approach by providing circulatory support during arrest, allowing time for diagnostic evaluation and targeted therapy. However, patient selection ECPR challenge, relying on various factors including initial rhythm, duration no-flow low-flow states, as well presence reversible causes.Recent studies such ARREST, Prague OHCA INCEPTION trials investigated efficacy patients, yielding mixed results. While ARREST trial demonstrated survival benefit with ECPR, showed varying outcomes, reflecting complexity treatment strategies. inherent risks complications associated it may offer potential advantage under optimal conditions.Future directions involve development innovative protocols CARL therapy, which incorporates specialized ECMO systems tailored perfusion solutions. Early indicate outcomes emphasizing importance well-coordinated structured to implementation.In summary, shows promise improving rates patients within well-organized healthcare system. further research is needed refine criteria optimize protocols, ultimately enhancing scenarios.

Language: Английский

Citations

0
Controlled automated reperfusion of the whole body after cardiac arrest: Device profile of the CARL system DOI Creative Commons
Christopher Gaisendrees,

M. Vollmer,

Georg Schlachtenberger

et al.

Artificial Organs, Journal Year: 2024, Volume and Issue: 48(12), P. 1384 - 1391

Published: Aug. 23, 2024

Abstract Background Cardiac arrest is associated with high mortality rates and severe neurological impairments. One of the underlying mechanisms global ischemia‐reperfusion injury body, particularly brain. Strategies to mitigate this may thus improve favorable outcomes. The use extracorporeal cardiopulmonary membrane oxygenation (ECMO) during CA has been shown survival, but available systems are vastly unable deliver goal‐oriented resuscitation control patient's individual physical chemical needs reperfusion. Recently, controlled automated reperfusion whoLe body (CARL), a pulsatile ECMO arterial blood‐gas analysis, introduced goal‐directed therapy post‐arrest phase. Methods This review focuses on device profile CARL. Specifically, we reviewed published literature summarize data regarding its technical features potential benefits in ECPR. Results Peri‐arrest, mitigating IRI ECMO, might be next step toward augmenting survival recovery. To end, CARL promising that improves early phase after resuscitation.

Language: Английский

Citations

0