PMID- 27865776
OWN - NLM
STAT- MEDLINE
DCOM- 20171227
LR  - 20180412
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 110
DP  - 2017 Jan
TI  - Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane 
      oxygenation: An observational study and propensity-score analysis.
PG  - 126-132
LID - S0300-9572(16)30545-7 [pii]
LID - 10.1016/j.resuscitation.2016.11.005 [doi]
AB  - PURPOSE: Cardiogenic shock due to post-resuscitation myocardial dysfunction is a 
      major cause of mortality among patients hospitalized after cardiac arrest (CA). 
      Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in 
      the most severe cases but the level of evidence is very low. We assessed 
      characteristics, outcome and prognostic factors of patients treated with VA-ECMO 
      for post-CA shock. METHODS: Using a large regional registry, we focused on all CA 
      admitted in ICU. Among those who developed a post-CA shock, prognostic was 
      compared according to VA-ECMO use, using logistic regression and propensity 
      score. Specific prognostic factors were identified among VA-ECMO patients. 
      RESULTS: Among 2988 patients admitted after CA, 1489 developed a post-CA shock, 
      and were included. They were mostly male (68%), with mean age 63 years (SD=15). 
      Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with 
      ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were 
      discharged alive (25% in VA-ECMO group, 21% in control group, P=0.45). After 
      adjustment for pre-hospital and in-hospital factors, survival did not differ 
      among patients treated with VA-ECMO (OR for survival=0.9, 95%CI 0.4-2.3, P=0.84). 
      After propensity-score matching, results were consistent. Among patients treated 
      with VA-ECMO, initial arterial pH (OR=1.7 per 0.1 increase, 95%CI 1.0-2.8, 
      P=0.04) and implantation of VA-ECMO over 24h after ROSC (OR=20.0, 95%CI 
      1.4-277.3, P=0.03) were associated with survival. CONCLUSIONS: Post-CA shock is 
      frequent and is associated with a high mortality rate. When used in selected 
      patients, we observed that VA-ECMO could be an appropriate treatment.
CI  - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved.
FAU - Bougouin, Wulfran
AU  - Bougouin W
AD  - Cardiology Department, Pompidou Hospital, APHP, Paris, France; 
      Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France.
FAU - Aissaoui, Nadia
AU  - Aissaoui N
AD  - Universite Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Medical ICU, 
      Pompidou Hospital, APHP, Paris, France.
FAU - Combes, Alain
AU  - Combes A
AD  - Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and 
      Nutrition, Pitie-Salpetriere Hospital, APHP, Paris, France.
FAU - Deye, Nicolas
AU  - Deye N
AD  - Medical ICU, Lariboisiere Hospital, AP-HP, Paris, France; INSERM U942, Paris, 
      France.
FAU - Lamhaut, Lionel
AU  - Lamhaut L
AD  - Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France; ICU and SAMU 75, Necker 
      Enfants-Malades Hospital, Paris, France.
FAU - Jost, Daniel
AU  - Jost D
AD  - Paris Sudden-Death-Expertise-Center, Paris, France; Paris Fire Brigade Emergency 
      Dept., Paris, France.
FAU - Maupain, Carole
AU  - Maupain C
AD  - Cardiology Department, Pitie-Salpetriere Hospital, APHP, Paris, France.
FAU - Beganton, Frankie
AU  - Beganton F
AD  - Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France.
FAU - Bougle, Adrien
AU  - Bougle A
AD  - Human Histopathology and Animal Models Unit, Infection and Epidemiology 
      Department, Institut Pasteur, Paris, France; Anesthesiology and Intensive Care, 
      Institut de Cardiologie, Pitie-Salpetriere Hospital, Paris, France.
FAU - Karam, Nicole
AU  - Karam N
AD  - Cardiology Department, Pompidou Hospital, APHP, Paris, France; 
      Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France.
FAU - Dumas, Florence
AU  - Dumas F
AD  - Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France; Emergency Department, 
      Cochin-Hotel-Dieu Hospital, APHP, Paris, France.
FAU - Marijon, Eloi
AU  - Marijon E
AD  - Cardiology Department, Pompidou Hospital, APHP, Paris, France; 
      Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France.
FAU - Jouven, Xavier
AU  - Jouven X
AD  - Cardiology Department, Pompidou Hospital, APHP, Paris, France; 
      Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France.
FAU - Cariou, Alain
AU  - Cariou A
AD  - Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Universite 
      Paris-Descartes-Sorbonne-Paris-Cite, Paris, France; Paris 
      Sudden-Death-Expertise-Center, Paris, France; Medical ICU, Cochin Hospital, 
      AP-HP, Paris, France. Electronic address: alain.cariou@cch.aphp.fr.
CN  - SDEC Investigators
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20161117
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
MH  - Aged
MH  - Cardiopulmonary Resuscitation/*adverse effects/methods
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - France/epidemiology
MH  - *Heart Arrest/complications/mortality/therapy
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Propensity Score
MH  - Registries/statistics & numerical data
MH  - *Shock, Cardiogenic/diagnosis/etiology/mortality/therapy
OTO - NOTNLM
OT  - Cardiac arrest
OT  - Extracorporeal life support
OT  - Shock
EDAT- 2016/11/21 06:00
MHDA- 2017/12/28 06:00
CRDT- 2016/11/21 06:00
PHST- 2016/08/03 00:00 [received]
PHST- 2016/10/24 00:00 [revised]
PHST- 2016/11/01 00:00 [accepted]
PHST- 2016/11/21 06:00 [pubmed]
PHST- 2017/12/28 06:00 [medline]
PHST- 2016/11/21 06:00 [entrez]
AID - S0300-9572(16)30545-7 [pii]
AID - 10.1016/j.resuscitation.2016.11.005 [doi]
PST - ppublish
SO  - Resuscitation. 2017 Jan;110:126-132. doi: 10.1016/j.resuscitation.2016.11.005. 
      Epub 2016 Nov 17.