Abstract 2656: Effect of Assisted Circulation in Prolonged Cardiopulmonary Resuscitation
Introduction - Application of extracorporeal life support (ECLS) in patients undergoing cardiopulmonary resuscitation (CPR) had been advocated with acceptable survival but no enough evidence of comparing the conventional cardiopulmonary resuscitation could be provided.
Hypothesis - The ECLS application in prolonged CPR (> 10 min) might provide better survival-to discharge rate.
Material - Consecutive patients with cardiac arrest receiving CPR over 10 minutes without return of spontaneous circulation (ROSC) and no absolute contraindication for assisted circulation were rescued with venoarterial ECLS (group ECPR). The in-hospital CPR patients with CPR > 10 min and without ECLS in recent 2 years were collected as the control group to compare the result.
Result - The survival rate was was 32.4% of total 142 ECPR patients, including 7 out-of-hospital CPR and 135 in-hospital CPR. In-hospital ECPR had significant better survival rate than out-of hospital arrest with ECLS (34.1% vs. 0%, p < 0.0001). Regarding to the conventional in-hospital prolonged CPR, the rate of ROSC was 63% (213/339) but the survival rate was lower than ECPR group (10.3% vs 32.4%, p < 0.0001). Even for the subgroup of prolonged CPR with ROSC, the ECPR group still had better survival than prolonged CPR with ROSC (16.4%, p = 0.004). Detailed analysis of the in-hospital ECPR (n=135) revealed PCR duration beyond 60 min had significant poor outcome than those less than 60 min (p < 0.0001). Cox regression analysis demonstrated age, CPR duration, first measured lactate, and subsequent procedure were risk factor for non-survival.
Conclusion -Compared to the conventional CPR, ECPR proved to be effective in survival. It can prevent the secondary shock damage after CPR. However, ECLS may be not recommended for those with out-of hospital arrest.