{"id":3534,"date":"2017-10-06T00:43:54","date_gmt":"2017-10-06T04:43:54","guid":{"rendered":"https:\/\/edecmo.org\/?p=3534"},"modified":"2017-10-06T19:24:46","modified_gmt":"2017-10-06T23:24:46","slug":"edecmo-39-put-ecmo-new-data-prognostics","status":"publish","type":"post","link":"https:\/\/edecmo.org\/edecmo-39-put-ecmo-new-data-prognostics\/","title":{"rendered":"EDECMO 39:  Who Do We Put On ECMO? &#8211; New Data on Prognostics"},"content":{"rendered":"<!--powerpress_player--><div class=\"powerpress_player\" id=\"powerpress_player_9784\"><!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-3534-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/Prognostic2.mp3?_=1\" \/><a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/Prognostic2.mp3\">http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/Prognostic2.mp3<\/a><\/audio><\/div><p class=\"powerpress_links powerpress_links_mp3\" style=\"margin-bottom: 1px !important;\">Podcast: <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/Prognostic2.mp3\" class=\"powerpress_link_pinw\" target=\"_blank\" title=\"Play in new window\" onclick=\"return powerpress_pinw('https:\/\/edecmo.org\/?powerpress_pinw=3534-podcast');\" rel=\"nofollow\">Play in new window<\/a> | <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/Prognostic2.mp3\" class=\"powerpress_link_d\" title=\"Download\" rel=\"nofollow\" download=\"Prognostic2.mp3\">Download<\/a> (Duration: 36:15 &#8212; 31.0MB)<\/p><p class=\"powerpress_links powerpress_subscribe_links\">Subscribe: <a href=\"https:\/\/edecmo.org\/feed\/podcast\/\" class=\"powerpress_link_subscribe powerpress_link_subscribe_rss\" target=\"_blank\" title=\"Subscribe via RSS\" rel=\"nofollow\">RSS<\/a><\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3551\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/10\/Picture1-740x232.png\" alt=\"\" width=\"740\" height=\"232\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/10\/Picture1-740x232.png 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/10\/Picture1-768x241.png 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/10\/Picture1-1024x321.png 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/10\/Picture1.png 1993w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/p>\n<p>In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of \u201cWho should I put on ECMO?\u201d\u00a0 Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important.\u00a0 Guillaume&#8217;s data shows importance of short low times, lower lactates and higher pH values.\u00a0 The real question is what number for each of these should we consider a hard stop on initiation.\u00a0 This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial.\u00a0 He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had &gt;30 minutes of chest compressions.\u00a0 With many ECMO studies having average arrest to<\/p>\n<p>initiation times of &gt; 60 minutes, Josh\u2019s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide.\u00a0 This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age &lt; 65.\u00a0\u00a0 We\u00a0 conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival.\u00a0 This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this.<\/p>\n<p>&nbsp;<\/p>\n<p>Bibliography:<\/p>\n<p>1: Haas NL, Coute RA, Hsu CH, Cranford JA, Neumar RW. Descriptive analysis of<br \/>\nextracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac<br \/>\narrest-An ELSO registry study\u2028. Resuscitation. 2017 Oct;119:56-62. doi:<br \/>\n10.1016\/j.resuscitation.2017.08.003. Epub 2017 Aug 5. PubMed PMID: <span id=\"a10fh01soju\" class=\"abt-citation noselect mceNonEditable\" data-reflist=\"[&quot;f3eqdoem9&quot;]\"><sup>1<\/sup><\/span>.<\/p>\n<p>&nbsp;<\/p>\n<p>2: Reynolds JC, Grunau BE, Elmer J, Rittenberger JC, Sawyer KN, Kurz MC, Singer<br \/>\nB, Proudfoot A, Callaway CW. Prevalence, natural history, and time-dependent<br \/>\noutcomes of a multi-center North American cohort of out-of-hospital cardiac<br \/>\narrest extracorporeal CPR candidates. Resuscitation. 2017 Aug;117:24-31. doi:<br \/>\n10.1016\/j.resuscitation.2017.05.024. Epub 2017 May 25. PubMed PMID: <span id=\"a1oc4ev2ha6\" class=\"abt-citation noselect mceNonEditable\" data-reflist=\"[&quot;z256ofcdon&quot;]\"><sup>2<\/sup><\/span>.<\/p>\n<p>&nbsp;<\/p>\n<p>3: Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M,<br \/>\nBouvaist H, Chavanon O, Maignan M, Bouzat P, Albaladejo P, Labar\u00e8re J. Prognostic<br \/>\nfactors for extracorporeal cardiopulmonary resuscitation recipients following<br \/>\nout-of-hospital refractory cardiac arrest. A systematic review and meta-analysis.<br \/>\nResuscitation. 2017 Mar;112:1-10. doi: 10.1016\/j.resuscitation.2016.12.011. Epub<br \/>\n2016 Dec 19. Review. PubMed PMID: <span id=\"acfni1vm53\" class=\"abt-citation noselect mceNonEditable\" data-reflist=\"[&quot;gab5of3la&quot;]\"><sup>3<\/sup><\/span>.<\/p>\n<div id=\"abt-bibliography\" class=\"abt-bibliography noselect mceNonEditable\">\n<h3 class=\"abt-bibliography__heading abt-bibliography__heading_toggle\">References<\/h3>\n<div id=\"abt-bibliography__container\" class=\"abt-bibliography__container\">\n<div id=\"f3eqdoem9\">\n<div class=\"csl-entry flush\">\n<div class=\"csl-left-margin\">1.<\/div>\n<div class=\"csl-right-inline\">Haas N, Coute R, Hsu C, Cranford J, Neumar R. Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-An ELSO registry study\u2028. <i>Resuscitation<\/i>. 2017;119:56-62.<span class=\"abt-url\"> [<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28789990\" target=\"_blank\" rel=\"noopener\">PubMed<\/a>]<\/span><\/div>\n<\/div>\n<\/div>\n<div id=\"z256ofcdon\">\n<div class=\"csl-entry flush\">\n<div class=\"csl-left-margin\">2.<\/div>\n<div class=\"csl-right-inline\">Reynolds J, Grunau B, Elmer J, et al. Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates. <i>Resuscitation<\/i>. 2017;117:24-31.<span class=\"abt-url\"> [<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28552656\" target=\"_blank\" rel=\"noopener\">PubMed<\/a>]<\/span><\/div>\n<\/div>\n<\/div>\n<div id=\"gab5of3la\">\n<div class=\"csl-entry flush\">\n<div class=\"csl-left-margin\">3.<\/div>\n<div class=\"csl-right-inline\">Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. <i>Resuscitation<\/i>. 2017;112:1-10.<span class=\"abt-url\"> [<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28007504\" target=\"_blank\" rel=\"noopener\">PubMed<\/a>]<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of \u201cWho should I put on ECMO?\u201d\u00a0 Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important.\u00a0 Guillaume&#8217;s data shows importance of short low times, lower lactates and higher pH values.\u00a0 The real question is what number for each of these should we consider a hard stop on initiation.\u00a0 This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial.\u00a0 He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had >30 minutes of chest compressions.\u00a0 With many ECMO studies having average arrest to<\/p>\n<p>initiation times of > 60 minutes, Josh\u2019s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide.\u00a0 This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age < 65.\u00a0\u00a0 We\u00a0 conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival.\u00a0 This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this.\n<\/p>\n","protected":false},"author":5,"featured_media":3559,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[4],"tags":[120,72,159,56,266,265,268,267,264],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/10\/Cover2-700.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3JzC4-V0","_links":{"self":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/3534"}],"collection":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/comments?post=3534"}],"version-history":[{"count":0,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/3534\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media\/3559"}],"wp:attachment":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media?parent=3534"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/categories?post=3534"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/tags?post=3534"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}