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• W2912189952 abstract "We read the systematic review by Beyea et al.1Beyea M.M. Tillmann B.W. Iansavichene A.E. Randhawa V.K. Van Aarsen K. Nagpal A.D. Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: a systematic review.Resuscitation. 2018; 130: 146-158Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar with great interest. We were impressed by authors’ efforts to assess the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on neurologic outcome in out-of-hospital cardiac arrest (OHCA) patients. We strongly agree with the authors that current evidence supporting the routine use of ECPR for OHCA patients remains limited and that high quality randomized controlled trial data is urgently needed. However, we wish to add some additional comments regarding the selection criteria used in their study. Beyea et al. in their systematic review included patients suffering from non-traumatic OHCA of various causes. The aetiology of some OHCA may however be very specific, and representing a separate entity that requires special treatment. As noticed by the authors, two studies were found to have a specifically higher rate of survival 70%2Darocha T. Kosinski S. Jarosz A. et al.The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming.Scand J Trauma Resusc Emerg Med. 2016; 24: 85Crossref PubMed Scopus (21) Google Scholar and 71.4%3Daubin C. Lehoux P. Ivascau C. et al.Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases.Crit Care. 2009; 13: R138Crossref PubMed Scopus (83) Google Scholar. Both these studies indeed did not include patients with cardiac arrest (CA) of cardiac origin, but cases of OHCA secondary to accidental hypothermia2Darocha T. Kosinski S. Jarosz A. et al.The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming.Scand J Trauma Resusc Emerg Med. 2016; 24: 85Crossref PubMed Scopus (21) Google Scholar or drug intoxication3Daubin C. Lehoux P. Ivascau C. et al.Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases.Crit Care. 2009; 13: R138Crossref PubMed Scopus (83) Google Scholar. Hypothermic cardiac arrest is a very specific cause of CA, which justified the development of specific management guidelines4Truhlář A. Deakin C.D. Soar J. et al.European resuscitation council guidelines for resuscitation 2015: section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201Abstract Full Text Full Text PDF PubMed Scopus (600) Google Scholar. Cooling of the body decreases oxygen consumption by about 6% for every degree below 37 °C. Thus, the brain can tolerate cardiac arrest for up to 10 times longer at 18 °C than in normothermia and intact neurological recovery may be possible even after prolonged cardiac arrest4Truhlář A. Deakin C.D. Soar J. et al.European resuscitation council guidelines for resuscitation 2015: section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201Abstract Full Text Full Text PDF PubMed Scopus (600) Google Scholar. Out of 286 patients in hypothermic cardiac arrest identified recently by Pasquier et al. 37% survived, mostly (84%) with a good neurological outcome5Pasquier M. Hugli O. Paal P. et al.Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: the HOPE score.Resuscitation. 2018; 126: 58-64Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar. This was especially true for patients suffering from accidental hypothermia without component of asphyxia. OHCA inclusion of hypothermic origin in the study of Beyea and co-workers may therefore lead to the over-estimation of ECPR benefit for OHCA of cardiac arrest of other origin. On the other side, drawing conclusions from the systematic review by Beyea and al. should be conservative in particular with regard to OHCA from very specific cause like accidental hypothermia. The eligibility criteria that may identify the patients who will best benefit from ECPR in OHCA patient of presumed cardiac origin has still yet to be defined. At the same time, the role of ECPR in the management of OHCA from some specific causes appears to be well established. This is notably the case of patients suffering CA from accidental hypothermia, who have an excellent potential for survival with good neurological outcome. None declared. None. Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: A systematic reviewResuscitationVol. 130PreviewExtracorporeal membrane oxygenation-assisted CPR (ECPR) is an evolving adjunct for resuscitation of OHCA patients. The primary objective of this systematic review was to assess survival-to-hospital discharge with good neurologic recovery after OHCA among patients treated with ECPR compared to conventional CPR (CCPR). Full-Text PDF Reply to: The role of extracorporeal life support in patients with hypothermic cardiac arrestResuscitationVol. 134PreviewThank you for the opportunity to reply to Dr. Sylweriusz Kosiński and colleagues’ discussion of our systematic review1. We welcome and appreciate the feedback and additional insights into our study. Full-Text PDF" @default.
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• W2912189952 title "The role of extracorporeal life support in patients with hypothermic cardiac arrest" @default.
• W2912189952 doi "https://doi.org/10.1016/j.resuscitation.2018.10.015" @default.
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