Predictors for Survival and Good Neurological Outcome in E-CPR and Non CPR Treated Patients

Summary

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Description

75-80% of patients with cardiac arrest don't survive. Some of those, who despite advanced cardiopulmonary resuscitation don't get their circulation back, can be saved by ECMO-treatment. This is called E-CPR. In E-CPR the selection of patients is of uttermost importance. Despite this good selection c...

75-80% of patients with cardiac arrest don't survive. Some of those, who despite advanced cardiopulmonary resuscitation don't get their circulation back, can be saved by ECMO-treatment. This is called E-CPR. In E-CPR the selection of patients is of uttermost importance. Despite this good selection criteria are missing. ECMO-treatment it self is also associated with severe morbidity and high mortality, where long term evaluation of cognitive function is missing. In ECPR patients, pre arrest factors as well as measurable circulatory and other prognostic factors are measured during ECPR. Circulatory effect during ECPR is measured by end tidal carbon dioxide, NIRS-brain, pupil diameter, spontaneous movement, spontaneous breathing, serum lactate and lactate increase during CPR. All ECMO-treated patients at Sahlgrenska University hospital since 2010 are included. In December 2015 local selection guidelines for ECPR-initiation was created based on the literature and our early cohort. Those guidelines are evaluated in our 2016-2018 cohort with survival in good neurological status as outcome. Neurological prognostication according to European Guidelines of post cardiac arrest care is done, including early CT-scan of the brain, S-NSE, S100B, EEG, assessment of myoclonic status and pupil and corneal reflexes. The general CPR guidelines accuracy for survival with good neurological outcome in ECPR patients is tested. Both ECPR and ECMO-patients without previous CPR will have a long term follow up with standardized questionnaires (CPC, MRS, Mocca, Trailmaking test, MQ-5D, SF36, etc) and physiological and motor tests. Qualy will be calculated. The cost of the treatment in hospital will be assessed. The infection rate in all ECMO-patients from 2004- will be evaluated by blood and airway Cultures.

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