TY - JOUR
T1 - Extracorporeal Cardiopulmonary Resuscitation
T2 - a national study on the association between favourable neurological status and biomarkers of hypoperfusion, inflammation, and organ injury
AU - Gregers, Emilie
AU - Mørk, Sivagowry Rasalingam
AU - Linde, Louise
AU - Andreasen, Jo Bønding
AU - Smerup, Morten
AU - Kjærgaard, Jesper
AU - Møller-Sørensen, Peter Hasse
AU - Holmvang, Lene
AU - Christensen, Steffen
AU - Terkelsen, Christian Juhl
AU - Tang, Mariann
AU - Møller, Jacob Eifer
AU - Lassen, Jens Flensted
AU - Schmidt, Henrik
AU - Riber, Lars Peter
AU - Winther-Jensen, Matilde
AU - Thomassen, Sisse
AU - Laugesen, Helle
AU - Hassager, Christian
AU - Søholm, Helle
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2022/11/30
Y1 - 2022/11/30
N2 - AIMS: In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.METHODS AND RESULTS: This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 109/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission.CONCLUSION: Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.
AB - AIMS: In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.METHODS AND RESULTS: This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 109/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission.CONCLUSION: Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.
KW - Adult
KW - Biomarkers
KW - Cardiopulmonary Resuscitation/methods
KW - Humans
KW - Inflammation
KW - Lactates
KW - Out-of-Hospital Cardiac Arrest/therapy
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85162232273&partnerID=8YFLogxK
U2 - 10.1093/ehjacc/zuac135
DO - 10.1093/ehjacc/zuac135
M3 - Journal article
C2 - 36229928
SN - 2048-8726
VL - 11
SP - 808
EP - 817
JO - European heart journal. Acute cardiovascular care
JF - European heart journal. Acute cardiovascular care
IS - 11
ER -