Extracorporeal Pulmonary Resuscitation (ECPR) of Out-of-Hospital Cardiac Arrest

For decades, extracorporeal life support (commonly referred to as extracorporeal membrane oxygenation, or ECMO) was used in the operating room (OR) and ICU to treat refractory shock, typically after surgery. More recently, ECMO has been used to treat refractory cardiac arrest; in this indication, it takes the name “ECPR.” Today, ECPR is used in many places. Although there are published case reports, series and after/before studies, there have been no randomized controlled trials to illustrate its effectiveness in the resuscitation of out-of-hospital cardiac arrest (OHCA) patients. However, ECPR is now recommended by international guidelines in the management of refractory OHCA of suspected reversible cause, such as acute myocardial infarction, refractory cardiac arrest of suspected reversible cause, pulmonary embolism and intoxication.1 The 2015 American Heart Association Guidelines recommend ECPR could be considered in refractory cardiac arrest of suspected reversible cause.2 ECPR is the second line of treatment for OHCA not responding to usual BLS and ALS treatments (e.g., cardiac compressions/ massage, ventilation, defibrillation, drug administration, etc.). ECPR brings respiratory and circulatory support, ensuring sufficient blood and oxygen supply to the whole body, especially the brain. The ECPR response team in Paris implements ECMO on scene to restore blood flow to the body and limit ischemic consequences to the brain and coronary arteries. The hybrid impl...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Heart of America Source Type: news

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Koechlin L, Strebel I, Keller DI, Lohrmann J, Michou E, Kühne M, Reichlin T, Mueller C Abstract BACKGROUND: The utility of B-type Natriuretic Peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin (hs-cTn) concentrations for diagnosis and risk-stratification of syncope is incompletely understood. METHODS: We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against the ones of clinical assessments, in patients>45years presenting with syncope to the emergency department (ED) in a prospective diagnostic multice...
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
This study utilizes a national electronic health record (EHR) database to understand clinical outcomes with use of second-line treatments including: thrombopoietin receptor agonists (specifically, eltrombopag and romiplostim), rituximab, and splenectomy.METHODS: Utilizing the Optum EHR database, we identified patients who initiated a second-line treatment from Jan. 1, 2009 to Sep. 30, 2016 for primary or unspecified ITP. Additionally, patients included in the analysis had the following characteristics: 18 years or older; previous treatment with corticosteroids or immune globulin products; and active in the database for at ...
Source: Blood - Category: Hematology Authors: Tags: 311. Disorders of Platelet Number or Function: Poster II Source Type: research
Conclusion:Our analysis found that among DOACs rates of breakthrough VTE were significantly higher with rivaroxaban, and that reported rates of ischemic stroke were significantly higher with dabigatran. While no DOACs have been compared against each other in prospective trials, post-marketing reports have suggested that different safety profiles exist among DOACs, a finding reiterated by our analysis. The significantly higher rate of VTE reported with rivaroxaban as compared to other DOACs has not previously been described to the best of our knowledge and deserves further analysis. The two methods of comparing the anticoag...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Poster II Source Type: research
CONCLUSION: CP-CML patients treated with different TKIs (ponatinib, bosutinib, imatinib, dasatinib, and nilotinib) did not have different incidence of cardiovascular events (MACE, AOEs, VTEs) in this small cohort of real-world patients with ≥6-month of follow-up. The results were consistent among patients with prior use of one and two TKI types.DisclosuresLevy: Takeda (Millennium Pharmaceuticals, Inc.): Consultancy. Xie: STATinMED Research: Employment. Wang: STATinMED Research: Employment. Neumann: Takeda (Millennium Pharmaceuticals, Inc.): Employment. Srivastava: Takeda (Millennium Pharmaceuticals, Inc.): Employment. N...
Source: Blood - Category: Hematology Authors: Tags: 903. Outcomes Research-Non-Malignant Hematology: Poster II Source Type: research
CONCLUSION:  Utilizing FM concentrations to assess hyper-coagulable patients seems promising; however, there are limitations including variations in FM cut-off values, the effect of patient medications and the timing of FM measurement relative to an acute event. Thus, further investigation is required before a true advantage for FM as a haemostatic marker can be established. PMID: 30312978 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
AbstractPurposeA timely pharmacoinvasive strategy consisting of thrombolytic therapy (TT) plays a pivotal role in three major scenarios: acute ischemic stroke (AIS), acute myocardial infarction (STEMI), and massive pulmonary embolism (PE). Presence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate
Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
ConclusionsOver the last two decades Polish urban stroke units may have achieved a significant reduction of the occurrence of some noninfectious complications (i.e. MI, exacerbated CHF and DVT). However, the list of conditions associated with stroke unit mortality includes not only MI and exacerbated CHF but also PE, gastrointestinal bleeding and recurrent stroke.
Source: Polish Journal of Neurology and Neurosurgery - Category: Neurosurgery Source Type: research
Written by Pendell Meyers, edits by Steve SmithThis will be too easy for most long-time readers, but if you are at that level, sit back and enjoy noticing how few milliseconds it takes to recognize this thanks to so many prior examples on this blog!I was sent this ECG from EMS with only the information that it belonged to a middle aged male with left shoulder pain.What do you think?There are hyperacute T-waves in leads V1-V6, as well as in leads II, III, aVF. The J-points are all at baseline with the exception of leads V2-V3 which show a small amount of STD (which makes de Winter morphology in the presence of hyperacute T-...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Anticoagulation in atrial fibrillation (AF) secondary to acute coronary syndrome, acute pulmonary disease or sepsis may not prevent stroke, but may increase risk of bleeding, says an new study published in JACC Clinical Electrophysiology [1]. The authors retrospectively evaluated a cohort of over 2300 patients aged 65 years or more who were hospitalized with acute coronary syndrome, acute pulmonary disease which included worsening of chronic obstructive pulmonary disease, pneumonia, influenza, pulmonary embolism and pleural effusion or sepsis associated with new onset AF during admission. Over a three year follow...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology ECG / Electrophysiology Source Type: blogs
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