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. 2023 Dec 21;13(1):56.
doi: 10.3390/jcm13010056.

Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study

Georg Trummer  1   2 , Christoph Benk  1   2 , Jan-Steffen Pooth  2   3 , Tobias Wengenmayer  2   4 , Alexander Supady  2   4 , Dawid L Staudacher  2   4 , Domagoj Damjanovic  1   2 , Dirk Lunz  5 , Clemens Wiest  6 , Hug Aubin  7 , Artur Lichtenberg  7 , Martin W Dünser  8 , Johannes Szasz  8 , Dinis Dos Reis Miranda  9 , Robert J van Thiel  9 , Jan Gummert  10 , Thomas Kirschning  10 , Eike Tigges  11 , Stephan Willems  11 , Friedhelm Beyersdorf  1   2 , On Behalf Of The Extracorporeal Multi-Organ Repair Study Group
Affiliations

Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study

Georg Trummer et al. J Clin Med. .

Abstract

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6-26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues. Methods: This all-comers, multicenter, prospective observational study (69 patients with in- and out-of-hospital CA (IHCA and OHCA) after prolonged refractory CCPR) focused on extracorporeal cardiopulmonary support, comprehensive monitoring, multi-organ repair, and the potential for out-of-hospital cannulation and treatment. Result: The overall survival rate at hospital discharge was 42.0%, and a favorable neurological outcome (CPC 1+2) at 90 days was achieved for 79.3% of survivors (CPC 1+2 survival 33%). IHCA survival was very favorable (51.7%), as was CPC 1+2 survival at 90 days (41%). Survival of OHCA patients was 35% and CPC 1+2 survival at 90 days was 28%. The subgroup of OHCA patients with pre-hospital cannulation showed a superior survival rate of 57.1%. Conclusions: This new strategy focusing on repairing damage to multiple organs appears to improve outcomes after CA, and these findings should provide a sound basis for further research in this area.

Keywords: cardiac arrest; cardiopulmonary resuscitation; extracorporeal cardiopulmonary resuscitation; extracorporeal circulation; organ repair.

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Conflict of interest statement

The authors declare the following competing interests. G.T. is a shareholder of and consultant at Resuscitec GmbH. C.B. is a part-time employee and shareholder of Resuscitec GmbH. C.S., J.S.P., and S.J.B. are part-time employees of Resuscitec GmbH. F.B. is a founder and shareholder of Resuscitec GmbH, a start-up company of the University Hospital Freiburg, Germany. H.A., D.D.R.M., and E.T. received speaker honoraria from Resuscitec GmbH. The remaining authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Schematic presentation of the controlled automated reperfusion of the whole body and overview of the technology.
Figure 2
Figure 2
Duration of CCPR before the start of extracorporeal multi-organ therapy for N = 62/69 patients. Each column represents 10 min. The CCPR duration was >30 min for 73% of the patients; for 58% of the patients, the CCPR duration was >60 min.
See this image and copyright information in PMC

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