Resuscitation plus · 2026
Incidence and impact of loss of pulsatility on outcomes after extracorporeal cardiopulmonary resuscitation - A retrospective cohort study.
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Nanjayya Vinodh Bhagyalakshmi, Nichol Alistair, Kaye David M, Roberts Lloyd, Collins Kathleen, Sheldrake Jayne, Higgins Alisa M, Diehl Arne, Coull Julia, Burrell Aidan, Richardson Sacha, Orosz Judit, Pilcher David, Bernard Stephen, Nixon Paul, Pellegrino Vincent, Cooper D James
Аннотация
AIM: Loss of pulsatility, defined as zero pulse pressure, can occur following extracorporeal cardiopulmonary resuscitation (ECPR). The aim of this study was to determine the incidence of loss of pulsatility and assess its association with in-hospital mortality in ECPR patients.
METHODS AND SETTINGS: A retrospective cohort study of consecutive ECPR patients admitted between January 2011 and December 2024 to a high volume ECMO centre. Loss of pulsatility was defined as any documented pulse pressure (difference in systolic and diastolic arterial blood pressure) of 0 mmHg during the first 12 h following ECPR. Univariable and multivariable logistic regression models were used to identify association with in-hospital mortality.
RESULTS: During the study, 221 ECPR patients - mean age 50(±13.7) years, 165 (75%) males, met the inclusion criteria. At least one episode of loss of pulsatility occurred in 108 patients (49%). The loss of pulsatility group had a higher proportion of out-of-hospital cardiac arrest and longer arrest-to-ECMO time. In-hospital mortality was higher in the loss of pulsatility group (74% vs 48%; p < 0.01). After adjusting for location, first monitored rhythm, cause of cardiac arrest, and arrest-to-ECMO time, loss of pulsatility remained an independent predictor of mortality (OR 2.55 [95%CI 1.32-4.91]; p = 0.01). Each additional hour of loss of pulsatility was independently associated with an increased risk of mortality (OR 1.17 [95%CI 1.05-1.30]; p = 0.003).
CONCLUSIONS: Loss of pulsatility is an important predictor of mortality after ECPR. Future studies should elucidate the underlying causes of loss of pulsatility and determine whether strategies to prevent or treat it improve patient outcomes.
METHODS AND SETTINGS: A retrospective cohort study of consecutive ECPR patients admitted between January 2011 and December 2024 to a high volume ECMO centre. Loss of pulsatility was defined as any documented pulse pressure (difference in systolic and diastolic arterial blood pressure) of 0 mmHg during the first 12 h following ECPR. Univariable and multivariable logistic regression models were used to identify association with in-hospital mortality.
RESULTS: During the study, 221 ECPR patients - mean age 50(±13.7) years, 165 (75%) males, met the inclusion criteria. At least one episode of loss of pulsatility occurred in 108 patients (49%). The loss of pulsatility group had a higher proportion of out-of-hospital cardiac arrest and longer arrest-to-ECMO time. In-hospital mortality was higher in the loss of pulsatility group (74% vs 48%; p < 0.01). After adjusting for location, first monitored rhythm, cause of cardiac arrest, and arrest-to-ECMO time, loss of pulsatility remained an independent predictor of mortality (OR 2.55 [95%CI 1.32-4.91]; p = 0.01). Each additional hour of loss of pulsatility was independently associated with an increased risk of mortality (OR 1.17 [95%CI 1.05-1.30]; p = 0.003).
CONCLUSIONS: Loss of pulsatility is an important predictor of mortality after ECPR. Future studies should elucidate the underlying causes of loss of pulsatility and determine whether strategies to prevent or treat it improve patient outcomes.