Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest

a multicentre experience

Mark Dennis*, Peter McCanny, Mario D'Souza, Paul Forrest, Brian Burns, David A. Lowe, David Gattas, Sean Scott, Paul Bannon, Emily Granger, Roger Pye, Richard Totaro, Sydney ECMO Research Interest Group

*Corresponding author for this work

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Aim: To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications. Methods: Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres in Sydney, Australia. Measurements and main: results Thirty-seven patients underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age was 54 (IQR 47–58), 27 (73%) were male. Initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 20 patients (54%), pulseless electrical activity (n = 14, 38%), and asystole (n = 3, 8%). 27 (73%) arrests were witnessed and 30 (81%) patients received bystander CPR. Median time from arrest to initiation of ECMO flow was 45 min (IQR 30–70), and the median time on ECMO was 3 days (IQR 1–6). Angiography was performed in 54% of patients, and 27% required subsequent coronary intervention (stenting or balloon angioplasty 24%). A total of 13 patients (35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All survivors were discharged with favourable neurological outcome (Cerebral Performance Category 1 or 2). Pre-ECMO lactate level was predictive of mortality OR 1.35 (1.06–1.73, p = 0.016). Conclusions: In selected patients with refractory cardiac arrest, ECPR may provide temporary support as a bridge to intervention or recovery. We report favourable survival and neurological outcomes in one third of patients and pre-ECMO lactate levels predictive of mortality. Further studies are required to determine optimum selection criteria for ECPR.

Original languageEnglish
Pages (from-to)131-136
Number of pages6
JournalInternational Journal of Cardiology
Volume231
DOIs
Publication statusPublished - 15 Mar 2017
Externally publishedYes

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Keywords

  • cardiopulmonary resuscitation
  • CPR
  • extracorporeal membrane oxygenation
  • ECMO
  • ECPR
  • cardiac arrest
  • ELS
  • ECLS

Cite this

Dennis, M., McCanny, P., D'Souza, M., Forrest, P., Burns, B., Lowe, D. A., ... Sydney ECMO Research Interest Group (2017). Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a multicentre experience. International Journal of Cardiology, 231, 131-136. https://doi.org/10.1016/j.ijcard.2016.12.003