Affiliation:
1. The First Affiliated Hospital of Nanjing Medical University
Abstract
Abstract
Introduction
: Even after the introduction of extracorporeal cardiopulmonary resuscitation (ECPR), clinical prognosis following cardiac arrest (CA) remains poor. Post-cardiac arrest syndrome (PCAS) may contribute to cardiovascular instability and death after ECPR. Systemic inflammation constitutes is a significant component of PCAS, and the severity of PCAS is associated with the levels of inflammatory cytokines. Preliminary investigations supported further assessments of cytokine adsorption as adjunctive therapy for patients with Acute Respiratory Distress Syndrome (ARDS) and septic shock. This study aims to investigate whether cytokine adsorption can shorten the duration of Vein-Artery Extracorporeal Membrane Oxygenation (VA-ECMO) therapy in ECPR patients.
Methods and analysis:
The CAECR trial will be a single-center, randomized controlled, open-label trial. Patients will be randomized into two balanced parallel groups in a 1:1 ratio at the onset of ECMO initiation. Patients in the control group will undergo ECPR and receive standardized care, while those in the intervention group will undergo cytokine adsorption in addition to ECPR and receive standardized care. A 2-1-1 protocol will be adopted for cytokine adsorption: two units will be used for 12 h in the first 24 h, and then one unit per day for 24 h in the following 2 days. The primary outcome will be the duration of VA-ECMO therapy. The secondary outcomes will include related inflammatory markers, coagulation parameters, hemodynamic parameters, respiratory mechanics parameters, mechanical ventilation(MV) time, continuous renal replacement therapy(CRRT) time, and changes in vasoactive-inotropic score(VIS). To comprehensively evaluate the effect of cytokine adsorption on perioperative outcomes, we will also determine whether there are differences in the length of intensive care unit (ICU) stay, total hospitalization costs, and all-cause mortality.
Publisher
Research Square Platform LLC
Reference29 articles.
1. 1. Bougouin W, Dumas F, Lamhaut L, et al. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2020;41:1961–71.
2. 2. Patricio D, Peluso L, Brasseur A, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care 2019;23:27.
3. 3. Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Böttiger BW, Callaway C, Clark RS, Geocadin RG, Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation. 2008 Dec;79(3):350 − 79.
4. 4. Basu R, Pathak S, Goyal J, Chaudhry R, Goel RB, Barwal A. Use of a novel hemoadsorption device for cytokine removal as adjuvant therapy in a patient with septic shock with multi-organ dysfunction: a case study. Indian J Crit Care Med. 2014;18(12):822–4
5. 5. Träger K, Skrabal C, Fischer G, et al: Hemoadsorption treatment with CytoSorb® in patients with extracorporeal life support therapy: A case series. Int J Artif Organs 43: 422–429, 2020.