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  • 1
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    Online Resource
    Abstract 270: Combined Use of VA-ECMO and IMPELLA (ECPELLA) Can Improve Outcomes in Patients Who Underwent E-CPR
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_4 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_4 ( 2020-11-17)
    Abstract: Background: Extracorporeal CPR (E-CPR) using a veno-arterial ECMO (VA-ECMO) is effective for patients with refractory cardiac arrest. Intra-aortic balloon pumping (IABP) is often combined with VA-ECMO to increase coronary perfusion. However, this combination significantly increases left ventricular afterload. Recent studies showed VA-ECMO combined with IMPELLA pump (ECPELLA) had beneficial effect on refractory cardiogenic shock. Objective: Evaluate outcome of ECPELLA patients who underwent E-CPR as compared to ECMO with IABP. Method: We retrospectively reviewed 140 consecutive patients who underwent E-CPR from January 2012 through May 2020 in our institute. Thirty-eight patients who received ECMO alone were excluded, and 102 patients were recruited. Twenty-four patients underwent ECPELLA (ECPELLA group) and 78 patients underwent ECMO with IABP (IABP group). The 30-day survival rate and the rate of grades 1 and 2 Cerebral Performance Categories (CPC) as the neurological prognosis were assessed. Result: ECPELLA group showed significantly shorter time from cardiac arrest to ECMO placement compared to IABP group (24 min [IQR; 13-41] vs. 49 min [IQR; 28-75] ; P=0.0003). The rate of favorable neurological prognosis were significantly higher in the ECPELLA group (38% vs. 13% ; P=0.01). The 30-day all-cause mortality of ECPELLA was significantly lower than IABP (P=0.005 by log-rank test). Multivariate cox proportional hazard analysis including the age, Out of hospital cardiac arrest, shockable rhythm, Acute coronary syndrome, Collaapse-to-ECMO under 60min, and ECPELLA revealed that the age (hazard ratio [HR], 1.34 (10 years increase), 95%CI, 1.11-1.63, P=0.002), Collapse-to-ECMO under 60 min (HR, 0.45, 95%CI, 0.23-0.87, P=0.02) and ECPELLA (HR, 0.48, 95%CI, 0.22-0.95, P=0.035) were significantly associated with 30-day mortality. Conclusion: ECPELLA improves mortality and favorable neurological outcome in patients who underwent E-CPR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_4.270
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 2
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    Abstract 11816: Combined Use of VA-ECMO and IMPELLA (ECPELLA) Reduces Myocardial Damage and Mortality in Lethal Cardiogenic Shock Patients Due to Acute Coronary Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Background: Short-term mortality of lethal cardiogenic shock (CS) patients due to acute coronary syndrome (ACS) remains to be improved. The veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been applied as the effective lifesaving modality for CS patients. While VA-ECMO maintains end-organ perfusion, it increases the damaged left ventricular (LV) afterload. Combined treatment of VA-ECMO and a micro-axial Impella pump, ECPELLA, simultaneously provides the systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect by ECPELLA can reduce the myocardial damage and the mortality. Purpose: This study was to assess whether ECPELLA reduces myocardial damage and improves the mortality of CS patients due to ACS. Methods: From January 2012 to May 2021, 66 consecutive patients with lethal CS (SCAI stage-E) due to ACS were enrolled. All patients received VA-ECMO support prior to or after the percutaneous coronary intervention. Among them, 34 patients received ECPELLA and 32 patients received VA-ECMO + IABP. We assessed serum CK-MB levels and the cumulative 30-day mortality. Results: There were no significant difference in age, rate of male sex, coronary risk factors, ST elevated ACS, left main trunk (LMT) lesion, and the time from onset to reperfusion between two treatment groups. The ECPELLA group had significantly lower peak CK-MB and lower 30-day all-cause mortality compared to the VA-ECMO + IABP group [Peak CPK level: median (IQR); 295 (92-507) vs.580 (219-1090): p=0.002, the 30-day mortality rate: 50% vs. 76%: p=0.02, respectively]. Multivariate Cox proportional hazard analysis including age, the time form onset to reperfusion, LMT lesion, E-CPR, and ECPELLA revealed that the ECPELLA (HR: 0.30 95% confidence interval:0.13-0.64; p=0.002) was independently associated with the 30-day all-cause mortality. Conclusion: Results suggest that the ECPELLA reduces the myocardial damage shown by peak CK-MB and improves the 30-day mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.11816
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 3
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    Abstract 331: Impact Of Concomitant Use Of Veno-arterial Extracorporeal Membrane Oxygenation And Impella Support On Short-term Mortality In Acute Coronary Syndrome Patients With Refractory Cardiogenic Shock
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is one of effective therapeutic modalities for patients with cardiogenic shock (CS) and acute coronary syndrome (ACS). While VA-ECMO maintains end-organ perfusion, it increases damaged left ventricular (LV) wall tension. Combined treatment of VA-ECMO and a micro-axial Impella pump, referred to as ECPELLA, simultaneously provides systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect on ECPELLA support further reduces mortality compared to currently available VA-ECMO+IABP support. Purpose: Investigate whether ECPELLA can reduce mortality in ACS patients with severe cardiogenic shock who required VA-ECMO. Methods: From January 2012 to May 2022, 100 consecutive patients with ACS and CS who received VA-ECMO before or after percutaneous coronary intervention were enrolled. Patients were divided into two groups; 39 patients in the ECPELLA; and 61 patients in the VA-ECMO with IABP. We assessed peak serum CPK-MB levels and 30-day mortality. Results: There were no significant differences in age, rate of male sex, coronary risk factors, ST-elevated ACS, left main trunk (LMT) lesion, multi-vessel disease (MVD), number of coronary lesions, extracorporeal cardiopulmonary resuscitation, and the time from onset to reperfusion between two groups. The ECPELLA had lower peak CPK-MB levels compared to VA-ECMO with IABP, but the difference did not reach statistical significance (p=0.056). Kaplan-Meier analysis revealed that the ECPELLA had significantly lower 30-day mortality ( p=0.0016 ). Multivariable Cox proportional hazard analysis revealed that ECPELLA (HR: 0.22 95% confidence interval:0.11-0.45; p 〈 0.0001) was inversely and independently associated with 30-day all-cause mortality. Conclusion: ECPELLA treatment appeared to have advantage in reduction of 30-day mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.331
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Abstract 206: Neurological Outcomes and the Time From Collapse to the Initiation of Extracorporeal Membrance Oxygenation in Patients With Out-Of-Hospital and In-Hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 140, No. Suppl_2 ( 2019-11-19)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 140, No. Suppl_2 ( 2019-11-19)
    Abstract: Background: Encouraging results of extracorporeal cardiopulmonary resuscitation (E-CPR) for patients with refractory cardiac arrest have been shown. However, an optimal timing to switch from conventional CPR to E-CPR are not well established. To determine the optimal timing when E-CPR should be performed, we investigated the relationship between the time from collapse to the initiation of extracorporeal membrane oxygenation (Collapse-to-ECMO time ) and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) treated with E-CPR. Methods: A total of 80 consecutive patients (age 64±16 years, male ratio 76%, shockable rhythm 48%, and OHCA 51%) received E-CPR between January 2012 and May 2019. The primary endpoint was survival with good neurological outcomes at hospital discharge (a cerebral performance category of 1 or 2). Results: Of the 80 patients included, 8 had good neurological outcomes. The rate of male was significantly higher in the good outcome group compared with the non-good outcome group. There was no significant difference in the age and the rates of initial shockable rhythm and acute coronary syndrome between the two groups. IHCA had the better outcomes compared with OHCA, but the difference does not reach significance [15.4% (6 of 39) vs. 4.9% (2 of 41); P=0.1]. The median Collapse-to-ECMO time was significantly shorter in the good outcome group compared with the non-good outcome group (38.5 min, interquartile range [IQR] , 19.3-54.5 vs. 58.5 min, IQR, 35.3-76.0: p = 0.04). The area under the receiver operating curve of the Collapse-to-ECMO time for predicting a good neurological outcome was 0.72, and the optimal cutoff time was 60 min. Stepwise multivariate logistic regression analysis including data on age, sex, shockable rhythm, OHCA, and the Collapse-to-ECMO time under 60 min revealed that a male sex (P=0.03), shockable rhythm (P=0.03) and the Collapse-to-ECMO time under 60 min (P 〈 0.001) were significantly associated with the good outcome. Conclusions: The Collapse-to-ECMO time was independently associated with good neurological outcomes. In patients with refractory cardiac arrest, it may be considered to initiate E-CPR within 60 min from collapse regardless of OHCA or IHCA.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.140.suppl_2.206
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 5
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    Abstract 12052: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome of Patients With Refractory Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with refractory cardiac arrest (CA). To improve the outcome of E-CPR, we developed a comprehensive simulation-based E-CPR training program. In the present study we assessed whether the E-CPR training improved the mortality and the neurological outcome. Methods: We have implemented the comprehensive E-CPR simulation training program twice a year to the medical team, which consists of emergency physicians, cardiologists, nurses, clinical engineers, and radiographers using a mock vascular model for E-CPR (ECMO cannulation). We assessed collapse to ECMO time, cumulative 30-day survival and good neurological outcome at hospital discharge defined as the cerebral performance categories (CPC) of 1 or 2. Results: Fifty-three consecutive patients received E-CPR for OHCA from January 2012 to December 2020 in which 31 patients were prior to (until September 2017) and 22 were after (from October 2017) the initiation of the E-CPR training. No differences were found in age, rates of witnessed and bystander-CPR, shockable rhythms, or acute coronary syndrome (ACS). Intra-aortic balloon pump was used in 87% patients prior to and 27% patients after the training (p 〈 0.001), and a microaxial Impella pump was used in 55% after the training. Collapse to ECMO time was significantly shorter after the training (p 〈 0.001). Cumulative 30-day survival and the rate of favorable neurological outcome were significantly higher after the training (p 〈 0.05). Multivariate cox proportional hazard analysis revealed that age (hazard ratio [HR], 1.38 (10 years increase), 95% confidence interval [CI] , 1.12-1.73, p=0.002), Collapse to ECMO time (HR, 1.14, 95%CI, 1.04-1.23, p=0.006), and additional Impella use (HR, 0.23, 95% CI, 0.08-0.69, p=0.0009) were significantly associated with the 30-day survival. Conclusions: The E-CPR training significantly improved the collapse to ECMO time. The faster deployment of ECMO improves the neurological outcome and 30-day survival in patients with refractory CA. Additional use of Impella may improve the survival.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.12052
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
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    Abstract 13359: Acute Phase Predictors for In-hospital Mortality and Chronic Thromboembolic Pulmonary Hypertension in Acute Pulmonary Embolism Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Background: Various predictors in patients with acute pulmonary embolism (PE) have been reported for in-hospital mortality and chronic thromboembolic pulmonary hypertension (CTEPH), but none have been established conclusively. Methods and Results: We retrospectively analyzed data that might be associated with in-hospital mortality and CTEPH from patients with acute PE who were admitted to our hospital. Among 163 patients (aged 69.3± 14.6 years) with acute PE, 11 patients (6.7%) died in the hospital. We examined the following acute and chronic-phase data: vital signs, echocardiography values, medications, laboratory test results, blood gas data and heparin infusion time. Multivariate logistic regression analysis showed that the acute-phase levels of plasma B-type natriuretic peptide (BNP) (odds ratio (OR), 1.003; 95% confidence interval (CI), 1.0004-1.0053; P = 0.034,) and arterial blood gas lactate (OR, 1.306; 95% CI, 1.056-1.615; P = 0.014) were significant independent predictors of in-hospital mortality. The area under the receiver operating characteristic (AUROC) curves of BNP and arterial blood lactate levels for in-hospital mortality were 0.846 and 0.921, respectively. (BNP, 400.65 pg/mL [sensitivity 77.8%, specificity 84.6%]; lactate 7.9 mmol/L [sensitivity 81.8%, specificity 89.5%] ). In univariate logistic regression analysis, the plasma BNP level 〉 400.65 pg/mL and lactate level 〉 7.9 mmol/L on admission were significant predictors for in-hospital mortality (OR 62.5, 95% CI 10.0-390.3; P = 0.0001). Among 152 patients (aged 68.9±14.6 years) with acute PE who did not die in-hospital, 15 (9.8%) patients progressed to CTEPH. Multivariate logistic regression analysis showed that right ventricular systolic pressure (RVSP) at admission was an independent and significant predictor for CTEPH (OR, 1.183; 95% CI, 1.090-1.285; P = 0.0001). The AUROC curve of RVSP for developing CTEPH was 0.944. (RVSP, 51.4 mm Hg [sensitivity 86.7%, specificity 83.8%] ). Conclusions: In patients with acute PE, the acute-phase BNP and arterial blood lactate levels are effective predictors of in-hospital mortality. And RVSP during the acute phase, but not during the chronic phase is an effective predictor of progression to CTEPH.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13359
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 7
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    Abstract 13900: Combined Use of Venoarterial Extracorporeal Menbrane Oxygenation and Impella Improves the Outcome in Patients With Cardiogenic Shock
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides benefit to patients in refractory cardiac arrest and cardiogenic shock. However, VA-ECMO elevates LV afterload and causes pulmonary edema and LV distension. Additional IABP support has been recommended in Japan to reduce LV afterload. Alternatively, transcatheter left ventricular assist device, Impella has been recently introduced. However, it remains to be evaluated if there is clinical benefit of concomitant use of VA-ECMO and Impella (ECPELLA). Methods: Aim of this single-site cohort study is to assess the effects of ECPELLA as compared with ECMO with IABP in patients who were managed with VA-ECMO due to refractory cardiogenic shock including cardiac arrest. Results: We retrospectively reviewed 253 consecutive patients, who received VA-ECMO from January 2012 to May 2022 in our institute. Among them, 67 patients who were managed with VA-ECMO alone were excluded. Patients were divided into two groups, ECEPLLA (n=68) and ECMO with IABP (n=118). We applied propensity score analysis with 1:1 score matching using dependent variables of age, the rate of sex, acute coronary syndrome, out-of-hospital and in-hospital cardiac arrest, and extracorporeal cardio-pulmonary resuscitation. We assessed 30-day survival rate, hemodynamic data, and safety profiles including acute kidney injury, blood transfusion and embolic cerebral infarction. Results: Following propensity score matching, 60 ECPELLA and 60 ECMO with IABP patients were included for analysis. The 30-day survival was significantly higher with ECPELLA group compared with ECMO with IABP group (ECPELLA: 48% vs. ECMO with IABP: 28%, p= 0.01, log-rank test). There were no statistical differences in ECMO weaning rate and safety profiles between treatment groups. Conclusions: ECPELLA may be associated with improved 30-day survival in patients with refractory cardiac shock including cardiac arrest.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 8
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    Online Resource
    Impact of extracorporeal CPR with transcatheter heart pump support (ECPELLA) on improvement of short-term survival and neurological outcome in patients with refractory cardiac arrest – A single-site retrospective cohort study
    Elsevier BV ; 2022
    In:  Resuscitation Plus Vol. 10 ( 2022-06), p. 100244-
    Details
    In: Resuscitation Plus, Elsevier BV, Vol. 10 ( 2022-06), p. 100244-
    Type of Medium: Online Resource
    ISSN: 2666-5204
    URL: Article
    DOI: 10.1016/j.resplu.2022.100244
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 3050870-8
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  • 9
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    Three Cases of LMT-STEMI with Cardiogenic Shock Under ECPELLA Support with Different Levels of Left Ventricular Unloading
    The Japanese Coronary Association ; 2023
    In:  Journal of Coronary Artery Disease Vol. 29, No. 2 ( 2023), p. 43-48
    Details
    In: Journal of Coronary Artery Disease, The Japanese Coronary Association, Vol. 29, No. 2 ( 2023), p. 43-48
    Type of Medium: Online Resource
    ISSN: 2434-2173
    URL: Article
    DOI: 10.7793/jcad.29.23-00001
    Language: English
    Publisher: The Japanese Coronary Association
    Publication Date: 2023
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  • 10
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    Abstract 11895: Impact of Prehospital Mobile Cloud ECG System to Reduce Door to Balloon Time and Onset to Recanalization Time in STEMI
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Background: Clinical guidelines strongly recommend patients with ST-elevation myocardial infarction (STEMI) receive timely mechanical reperfusion, defined as door-to-balloon time (DTBT) ≤90 minutes. Recently, mobile cloud 12-lead ECG transmission system (C-ECG) were becoming popular at low cost. Medical staff can immediately review the ECG via PC or personal hand-held devices, and also track the location of the ambulance in a real time manner. Objective: Evaluate the impact of the prehospital C-ECG on DTBT and mortality in patients with STEMI. Methods: In June 2018, eight mobile C-ECG systems (SCUNA®, MEHERGEN GROUP) were integrated into the Uki city and Kamimashiki city regional EMS departments in Kumamoto Prefecture, We compared the DTBT, onset to recanalization time (OTRT) and mortality rates of STEMI cases for 3 years prior to and 3 years after the C-ECG system. Results: For 6 years study period, 267 STEMI patients were transferred by ambulances from two EMS departments. After excluding 14 patients with onset to arrival time more than 24 hours and 54 patients who were transferred without C-ECG, 199 consecutive STEMI cases underwent emergency PCI in which 100 were prior to C-ECG introduction (Pre-C-ECG, from June 2015 to May 2018) and 99 were after C-ECG (Post-C-ECG, from June 2018 to May 2021). Results: No significant differences were found in age, gender, and Killip classification between the groups. The DTBT and OTRT were significantly shorter in the post-C-ECG compared to the pre-C-ECG (Pre: 68 min [IQR; 43-76] vs. Post: 50 min [IQR; 43-76] ; p=0.005, Pre: 190 min [IQR; 138-294] vs. Post: 157 min [IQR; 112-276] ; P=0.04, respectively). However, peak-CPK and the in-hospital mortality were not significantly different (Pre: 2068 IU/L [IQR; 1168-4200] vs. Post: 2105 IU/L [IQR; 872-4528] ; p=0.8, Pre: 7.0% vs. Post: 5.1%; p=0.6, respectively). Conclusion: Although the prehospital mobile C-ECG system significantly reduced both DTBT and OTRT, the DTBT at our institution was short enough that C-ECG did not reduce the peak CPK or mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.11895
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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