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Time matters in patients undergoing extracorporeal cardiopulmonary resuscitation
G Model
ARTICLE IN PRESS
RESUS-7160; No. of Pages 1
Resuscitation xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Time matters in patients undergoing extracorporeal cardiopulmonary resuscitation Sir, With great interest we read the publication of Kuroki et al. [1] demonstrating that prognosis strongly correlates with time to coronary reperfusion in patients with acute coronary syndromes and extracorporeal cardiopulmonary resuscitation (ECPR). First of all, we have to congratulate Kuroki and coworkers to their important study. In the subset of ECPR patients with an average time to extracorporeal membrane oxygenation (ECMO) of 21.7 min and time to reperfusion of 47.2 min they achieved a good neurological outcome in 74% of all patients. This outcome is impressive and comparable to outcome of patients with acute coronary syndromes and cardiogenic shock [2]. The authors conclude that time from collapse to ECMO (CtoE) and time from collapse to reperfusion (CtoR) correlate with survival and good neurological outcome. From our point of view, the presented data does not fully support the authors main finding that time to reperfusion (CtoR) is a significant independent predictor of poor neurological outcome. Since CtoR is composed out of time from collapse to ECMO (CtoE), the duration of ECMO cannulation and the duration of percutaneous coronary intervention, CtoR depends on CtoE. Presented data suggest a linear correlation of CtoR and CtoE. Due to collinearity, a multivariate analysis using both parameters should not be performed. Furthermore, independent effects of CtoR or CtoE cannot be discriminated. Still, findings presented highlight the importance of accelerating ECMO implantation in eCPR [3] as well as the importance of an aggressive treatment of the underlying disease [4]. As pointed out by Kuroki et al., every minute counts in ECPR as it does in cardiopulmonary resuscitation.
References [1].Kuroki N, Abe D, Iwama T, Suzuki K, Sugiyama K, Akashi A, et al. Association between delay to coronary reperfusion and outcome in patients with acute coronary syndrome undergoing extracorporeal cardiopulmonary resuscitation. Resuscitation 2017;114:1–6. [2].Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, openlabel trial. Lancet (London, England) 2013;382:1638–45. [3].Leick J, Liebetrau C, Szardien S, Fischer-Rasokat U, Willmer M, van Linden A, et al. Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol 2013;102:661–9. [4].Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock: SHOCK investigators. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 1999;341:625–34.
Dawid L. Staudacher a,b,∗ Christoph Bode a,b Tobias Wengenmayer a,b a Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, Germany b Department of Cardiology and Angiology I, University Heart Center Freiburg University, Germany ∗ Corresponding author at: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg, Germany. E-mail address: [email protected] (D.L. Staudacher)
18 April 2017
Conflicts of interest statement No conflict of interest for any author.
http://dx.doi.org/10.1016/j.resuscitation.2017.04.026 0300-9572/© 2017 Elsevier B.V. All rights reserved.
Please cite this article in press as: Staudacher DL, et al. Time matters in patients undergoing extracorporeal cardiopulmonary resuscitation. Resuscitation (2017), http://dx.doi.org/10.1016/j.resuscitation.2017.04.026
ARTICLE IN PRESS
RESUS-7160; No. of Pages 1
Resuscitation xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Time matters in patients undergoing extracorporeal cardiopulmonary resuscitation Sir, With great interest we read the publication of Kuroki et al. [1] demonstrating that prognosis strongly correlates with time to coronary reperfusion in patients with acute coronary syndromes and extracorporeal cardiopulmonary resuscitation (ECPR). First of all, we have to congratulate Kuroki and coworkers to their important study. In the subset of ECPR patients with an average time to extracorporeal membrane oxygenation (ECMO) of 21.7 min and time to reperfusion of 47.2 min they achieved a good neurological outcome in 74% of all patients. This outcome is impressive and comparable to outcome of patients with acute coronary syndromes and cardiogenic shock [2]. The authors conclude that time from collapse to ECMO (CtoE) and time from collapse to reperfusion (CtoR) correlate with survival and good neurological outcome. From our point of view, the presented data does not fully support the authors main finding that time to reperfusion (CtoR) is a significant independent predictor of poor neurological outcome. Since CtoR is composed out of time from collapse to ECMO (CtoE), the duration of ECMO cannulation and the duration of percutaneous coronary intervention, CtoR depends on CtoE. Presented data suggest a linear correlation of CtoR and CtoE. Due to collinearity, a multivariate analysis using both parameters should not be performed. Furthermore, independent effects of CtoR or CtoE cannot be discriminated. Still, findings presented highlight the importance of accelerating ECMO implantation in eCPR [3] as well as the importance of an aggressive treatment of the underlying disease [4]. As pointed out by Kuroki et al., every minute counts in ECPR as it does in cardiopulmonary resuscitation.
References [1].Kuroki N, Abe D, Iwama T, Suzuki K, Sugiyama K, Akashi A, et al. Association between delay to coronary reperfusion and outcome in patients with acute coronary syndrome undergoing extracorporeal cardiopulmonary resuscitation. Resuscitation 2017;114:1–6. [2].Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, openlabel trial. Lancet (London, England) 2013;382:1638–45. [3].Leick J, Liebetrau C, Szardien S, Fischer-Rasokat U, Willmer M, van Linden A, et al. Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol 2013;102:661–9. [4].Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock: SHOCK investigators. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 1999;341:625–34.
Dawid L. Staudacher a,b,∗ Christoph Bode a,b Tobias Wengenmayer a,b a Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, Germany b Department of Cardiology and Angiology I, University Heart Center Freiburg University, Germany ∗ Corresponding author at: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg, Germany. E-mail address: [email protected] (D.L. Staudacher)
18 April 2017
Conflicts of interest statement No conflict of interest for any author.
http://dx.doi.org/10.1016/j.resuscitation.2017.04.026 0300-9572/© 2017 Elsevier B.V. All rights reserved.
Please cite this article in press as: Staudacher DL, et al. Time matters in patients undergoing extracorporeal cardiopulmonary resuscitation. Resuscitation (2017), http://dx.doi.org/10.1016/j.resuscitation.2017.04.026