Abstract 1763: Emergency Cardiopulmonary Bypass in the Treatment of Patients with Out-of-Hospital Cardiac Arrest
BACKGROUND In the 2005 AHA guideline for cardiopulmonary resuscitation (CPR), there was an insufficient evidence of invasive CPR with emergency cardiopulmonary bypass (CPB) for patients with out-of-hospital cardiac arrest. We have performed invasive CPR in patients who arrived at the emergency room (ER) in cardiac arrest and failed to respond to standard CPR.
METHODS We evaluated the role of emergency CPB for patients with out-of-hospital cardiac arrest from our prospective studies of invasive CPR plus hypothermia. Our criteria of induction of emergency CPB was as follows: age18 to 74 years, witnessed out-of-hospital cardiac arrest, collapse-to-patient’s-side interval < 15min, ventricular fibrillation as recorded rhythm on the way ER from scene, cardiac origin of the arrest and persistent cardiac arrest on ER arrival. After rapid initiation of the emergency CPB, intra-aortic balloon pumping and/or coronary reperfusion therapy was performed if needed. The primary endpoint was a favorable neurological outcome at the hospital discharge.
RESULTS A total of 141 patients meeting the criteria of emergency CPB were enrolled; 79 received bystander CPR and median collapse-to-CPB-initiation interval of 64 min. Of those, 122 patients were treated with hypothermia (34 C° for 3 days) and the hypothermia was initiated after ROSC as the study of extra-arrest cooling or before ROSC as the study of intra-arrest cooling. The return of spontaneous circulation (ROSC) was achieved in 89.4 % (126/141), but the primary outcome was low at 10.6 % (15/141). There was a significant difference in the rate of survival to hospital discharge among the 3 groups (5.3 % with normothermia group vs. 12.7 % with extra-arrest cooling group vs. 35 % with intra-arrest cooling group, p = 0.02), but the primary outcome did not differ (5.3 % with normothermia group vs. 10.7 % with extra-arrest cooling group vs. 15 % with intra-arrest cooling group, p = 0.61).
CONCLUSIONIn patients with failed standard CPR, emergency CPB produced high ROSC and early induction of hypothermia before ROSC using emergency CPB improved the chance of survival. However, the neurological benefit was limited to about 15 % of patients treated with emergency CPB plus hypothermia after out-of-hospital cardiac arrest.