Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study

BACKGROUND AND IMPORTANCE

Sudden cardiac arrest has a high incidence and often leads to death. A treatment option that might improve the outcomes in refractory cardiac arrest is Extracorporeal Cardiopulmonary Resuscitation (ECPR).

OBJECTIVES

This study investigates the number of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients eligible to ECPR and identifies clinical characteristics that may help to identify which patients benefit the most from ECPR.

DESIGN, SETTINGS AND PARTICIPANTS

A retrospective two-centre study was conducted in Rotterdam, the Netherlands. All IHCA and OHCA patients between 1 January 2017 and 1 January 2020 were screened for eligibility to ECPR. The primary outcome was the percentage of patients eligible to ECPR and patients treated with ECPR. The secondary outcome was the comparison of the clinical characteristics and outcomes of patients eligible to ECPR treated with conventional Cardiopulmonary Resuscitation (CCPR) vs. those of patients treated with ECPR.

MAIN RESULTS

Out of 1246 included patients, 412 were IHCA patients and 834 were OHCA patients. Of the IHCA patients, 41 (10.0%) were eligible to ECPR, of whom 20 (48.8%) patients were actually treated with ECPR. Of the OHCA patients, 83 (9.6%) were eligible to ECPR, of whom 23 (27.7%) were actually treated with ECPR. In the group IHCA patients eligible to ECPR, no statistically significant difference in survival was found between patients treated with CCPR and patients treated with ECPR (hospital survival 19.0% vs. 15.0% respectively, 4.0% survival difference 95% confidence interval -21.3 to 28.7%). In the group OHCA patients eligible to ECPR, no statistically significant difference in-hospital survival was found between patients treated with CCPR and patients treated with ECPR (13.3% vs. 21.7% respectively, 8.4% survival difference 95% confidence interval -30.3 to 10.2%).

CONCLUSION

This retrospective study shows that around 10% of cardiac arrest patients are eligible to ECPR. Less than half of these patients eligible to ECPR were actually treated with ECPR in both IHCA and OHCA.

Testosterone implants in specific neural sites activate female sexual behaviour

Sexual behaviour in most female mammals is regulated by oestrogen, often acting synergistically with progesterone. Moreover, the most important neural site of action for oestradiol is the ventromedial nucleus. In the female musk shrew, Suncus murinus, testosterone (T) activates sexual behaviour. Virgin females first engage in copulatory behaviour many hours in advance of follicular development and ovulation, when plasma oestradiol levels are very low. Testosterone, produced by the ovaries and the adrenal glands, must be aromatized centrally to oestradiol to initiate sexual behaviour. To identify the neural sites of action for T, ovariectomized females received unilateral hormone implants containing testosterone propionate. Hormone pellets were placed in 1 of several brain sites including the medial preoptic area and the dorsalmedial hypothalamus (DMH). Implants in either of these 2 sites, but not in the lateral preoptic area, internal capsule, nor anterior hypothalamus stimulated the induction of sexual behaviour. Hormone implants in the ventrolateral hypothalamus resulted in partially receptive animals. Immunocytochemistry was employed to determine which steroid receptors were present in the 2 behaviourally active sites. The medial preoptic area (MPO) and the dorsal and ventromedial hypothalamus both contain many cells that express oestrogen receptor immunoreactivity. A smaller subset of neurons in these regions are immunoreactive for androgen receptors. In summary, testosterone can act specifically in either the MPO or the DMH to induce female sexual behaviour. Both sites contain cells that express oestrogen and androgen receptors. Thus, testosterone may work via one or both of these steroid receptors to regulate behaviour.(ABSTRACT TRUNCATED AT 250 WORDS)