ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
-
Meta Analysis
Use of extracorporeal membrane oxygenation for adults in cardiac arrest (E-CPR): a meta-analysis of observational studies.
Published data on the use of extracorporeal membrane oxygenation (ECMO) as a supportive measure during or immediately after cardiopulmonary resuscitation (CPR) in adults (older than 18 years) shows mixed results. To assess the clinical outcomes of the use of ECMO in this modality and to look for predictors of mortality, we performed a meta-analysis (MA) of individual patients collected from observational studies. An electronic PubMed search restricted to English-language publications between 1990 and 2007, using a consensus restrictive criterion, retrieved 141 titles. ⋯ There was a negative trend in survival when manual CPR lasted >30 minutes without prompt ECMO initiation (OR 1.9; 95% CL, 0.9-4.2). This work confirms the expectations for a better survival when E-CPR is used in younger patients, for shorter periods of time and after expeditious implementation during or immediately after manual CPR. Neurologic sequelae and other major complications, although suspected to be high, are poorly described in the reviewed literature.
-
Randomized Controlled Trial
Cardiac output measurement by arterial pressure waveform analysis during optimization of biventricular pacing after cardiac surgery.
Biventricular pacing (BiVP) can optimize cardiac output (CO) in patients after cardiac surgery, so devices that calculate continuous CO from arterial pressure may be a useful tool. We investigated PulseCO for measuring CO during optimization by comparison with aortic flow probe measurement. Seven patients in the Biventricular Pacing After Cardiac Surgery (BiPACS) trial were studied. ⋯ In contrast, changes in mean arterial pressure did not reflect changes in CO (intraclass correlation coefficient = 0.02). Thus, PulseCO can measure continuous CO in open-chest patients after cardiac surgery, whereas underestimating changes occurring across 10-second pacemaker changes. Further studies in the closed chest are indicated.