Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: a systematic review.

Details

Serval ID
serval:BIB_AA9F9BB4241D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: a systematic review.
Journal
Artificial organs
Author(s)
Podsiadło P., Darocha T., Svendsen Ø.S., Kosiński S., Silfvast T., Blancher M., Sawamoto K., Pasquier M.
ISSN
1525-1594 (Electronic)
ISSN-L
0160-564X
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Prolonged cardiac arrest (CA) may lead to neurologic deficit in survivors. Good outcome is especially rare when CA was unwitnessed. However, accidental hypothermia is a very specific cause of CA. Our goal was to describe the outcomes of patients who suffered from unwitnessed hypothermic cardiac arrest (UHCA) supported with Extracorporeal Life Support (ECLS).
We included consecutive patients' cohorts identified by systematic literature review concerning patients suffering from UHCA and rewarmed with ECLS. Patients were divided into four subgroups regarding the mechanism of cooling, namely: air exposure; immersion; submersion; and avalanche. A statistical analysis was performed in order to identify the clinical parameters associated with good outcome (survival and absence of neurologic impairment).
A total of 221 patients were included into the study. The overall survival rate was 27% . Most of the survivors (83%), had no neurologic deficit. Asystole was the presenting CA rhythm in 48% survivors, of which 79% survived with good neurologic outcome. Variables associated with survival included the following: female gender (p<0.001); low core temperature (p=0.005); non-asphyxia-related mechanism of cooling (p<0.001); pulseless electrical activity as an initial rhythm (p<0.001); high blood pH (p<0.001); low lactate levels (p=0.003); low serum potassium concentration (p<0.001); and short resuscitation duration (p=0.004).
Severely hypothermic patients with unwitnessed CA may survive with good neurologic outcome, including those presenting as asystole. The initial blood pH, potassium and lactate concentration may help predict outcome in hypothermic CA.
Keywords
Accidental hypothermia, Cardiac arrest, ECPR, Resuscitation, Triage
Pubmed
Web of science
Create date
19/09/2020 12:28
Last modification date
04/11/2020 6:23
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