Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury

Emilie Gregers; Sivagowry Rasalingam Mørk; Louise Linde; Jo Bønding Andreasen; Morten Smerup; Jesper Kjærgaard; Peter Hasse Møller-Sørensen; Lene Holmvang; Steffen Christensen; Christian Juhl Terkelsen; Mariann Tang; Jacob Eifer Møller; Jens Flensted Lassen; Henrik Schmidt; Lars Peter Riber; Matilde Winther-Jensen; Sisse Thomassen; Helle Laugesen; Christian Hassager; Helle Søholm

doi:10.1093/ehjacc/zuac135

Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury

Emilie Gregers^*, Sivagowry Rasalingam Mørk, Louise Linde, Jo Bønding Andreasen, Morten Smerup, Jesper Kjærgaard, Peter Hasse Møller-Sørensen, Lene Holmvang, Steffen Christensen, Christian Juhl Terkelsen, Mariann Tang, Jacob Eifer Møller, Jens Flensted Lassen, Henrik Schmidt, Lars Peter Riber, Matilde Winther-Jensen, Sisse Thomassen, Helle Laugesen, Christian Hassager, Helle Søholm

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Aims In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR. Methods This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-and results 2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 10 ⁹/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission. Conclusion Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal: Acute Cardiovascular Care
Vol/bind	11
Nummer	11
Sider (fra-til)	808-817
Antal sider	10
ISSN	2048-8726
DOI	https://doi.org/10.1093/ehjacc/zuac135
Status	Udgivet - 30 nov. 2022

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Gregers, E., Mørk, S. R., Linde, L., Andreasen, J. B., Smerup, M., Kjærgaard, J., Møller-Sørensen, P. H., Holmvang, L., Christensen, S., Terkelsen, C. J., Tang, M., Møller, J. E., Lassen, J. F., Schmidt, H., Riber, L. P., Winther-Jensen, M., Thomassen, S., Laugesen, H., Hassager, C., & Søholm, H. (2022). Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury. European Heart Journal: Acute Cardiovascular Care, 11(11), 808-817. https://doi.org/10.1093/ehjacc/zuac135

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title = "Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury",

abstract = "Aims In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR. Methods This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-and results 2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 10 9/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission. Conclusion Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.",

keywords = "Extracorporeal cardiopulmonary resuscitation, Hypoperfusion, Inflammation, Neurological outcome, Organ injury, Out-of-hospital cardiac arrest, biomarkers",

author = "Emilie Gregers and M{\o}rk, {Sivagowry Rasalingam} and Louise Linde and Andreasen, {Jo B{\o}nding} and Morten Smerup and Jesper Kj{\ae}rgaard and M{\o}ller-S{\o}rensen, {Peter Hasse} and Lene Holmvang and Steffen Christensen and Terkelsen, {Christian Juhl} and Mariann Tang and M{\o}ller, {Jacob Eifer} and Lassen, {Jens Flensted} and Henrik Schmidt and Riber, {Lars Peter} and Matilde Winther-Jensen and Sisse Thomassen and Helle Laugesen and Christian Hassager and Helle S{\o}holm",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected].",

year = "2022",

month = nov,

day = "30",

doi = "10.1093/ehjacc/zuac135",

language = "English",

volume = "11",

pages = "808--817",

journal = "European Heart Journal: Acute Cardiovascular Care",

issn = "2048-8726",

publisher = "SAGE Publications Ltd",

number = "11",

}

Gregers, E, Mørk, SR, Linde, L, Andreasen, JB, Smerup, M, Kjærgaard, J, Møller-Sørensen, PH, Holmvang, L, Christensen, S , Terkelsen, CJ , Tang, M, Møller, JE, Lassen, JF, Schmidt, H, Riber, LP, Winther-Jensen, M, Thomassen, S, Laugesen, H, Hassager, C & Søholm, H 2022, 'Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury', European Heart Journal: Acute Cardiovascular Care, bind 11, nr. 11, s. 808-817. https://doi.org/10.1093/ehjacc/zuac135

Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury. / Gregers, Emilie; Mørk, Sivagowry Rasalingam; Linde, Louise et al.
I: European Heart Journal: Acute Cardiovascular Care, Bind 11, Nr. 11, 30.11.2022, s. 808-817.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Extracorporeal Cardiopulmonary Resuscitation

T2 - A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury

AU - Gregers, Emilie

AU - Mørk, Sivagowry Rasalingam

AU - Linde, Louise

AU - Andreasen, Jo Bønding

AU - Smerup, Morten

AU - Kjærgaard, Jesper

AU - Møller-Sørensen, Peter Hasse

AU - Holmvang, Lene

AU - Christensen, Steffen

AU - Terkelsen, Christian Juhl

AU - Tang, Mariann

AU - Møller, Jacob Eifer

AU - Lassen, Jens Flensted

AU - Schmidt, Henrik

AU - Riber, Lars Peter

AU - Winther-Jensen, Matilde

AU - Thomassen, Sisse

AU - Laugesen, Helle

AU - Hassager, Christian

AU - Søholm, Helle

PY - 2022/11/30

Y1 - 2022/11/30

N2 - Aims In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR. Methods This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-and results 2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 10 9/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission. Conclusion Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.

AB - Aims In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR. Methods This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-and results 2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 10 9/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission. Conclusion Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.

KW - Extracorporeal cardiopulmonary resuscitation

KW - Hypoperfusion

KW - Inflammation

KW - Neurological outcome

KW - Organ injury

KW - Out-of-hospital cardiac arrest

KW - biomarkers

UR - http://www.scopus.com/inward/record.url?scp=85162232273&partnerID=8YFLogxK

U2 - 10.1093/ehjacc/zuac135

DO - 10.1093/ehjacc/zuac135

M3 - Journal article

C2 - 36229928

SN - 2048-8726

VL - 11

SP - 808

EP - 817

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 11

ER -

Gregers E, Mørk SR, Linde L, Andreasen JB, Smerup M, Kjærgaard J et al. Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury. European Heart Journal: Acute Cardiovascular Care. 2022 nov. 30;11(11):808-817. Epub 2022 okt. 14. doi: 10.1093/ehjacc/zuac135

Extracorporeal Cardiopulmonary Resuscitation: A National Study on the Association Between Favorable Neurological Status and Biomarkers of Hypoperfusion, Inflammation, and Organ Injury

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