Abstract P53: Predictor of Return of Spontaneous Heart Beating on Cardiac Arrest Patients Treated with Extracorporeal Cardiopulmonary Resuscitation
Introduction: Under current resuscitation guidelines, cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECPR) is a low-grade recommendation limited to a small group of patients. A decision on initiation of ECPR during conventional CPR must be made as early as possible, because setting-up of extracorporeal circulation requires about 10 min and prolongation of CPR duration leads to an adverse outcome.
Purpose: We assessed a predictor of return of spontaneous heartbeat (ROSB) before initiation of extracorporeal circulation in ECPR.
Methods: Between February 2006 and April 2009, 62 in- or out-of-hospital cardiac arrest patients who did not respond to conventional CPR were treated with ECPR at Hiroshima City Hospital. ECPR using percutaneous femoro-femoral cardiopulmonary bypass consisting of a centrifugal pump, a membrane oxygenator, and bypass cannulas was initiated under continuous chest compression. Patients were divided into two groups according to ROSB (ROSB-group) or failure to achieve ROSB (D-group) and assessed their clinical characteristics before initiation of extracorporeal circulation.
Results: ROSB was observed in 82% of patients, 47% were weaned from cardiopulmonary bypass, 15% survived to hospital discharge, and 11% had favorable neurologic findings at the time of hospital discharge. The ROSB-group was younger than the D-group (median 58 years [interqurtile range 53–68] vs 70 years [61–79], P=0.04). The time interval from collapse to start of CPR was significantly shorter in ROSB-group than in D-group (1 min [0–2] vs 3 min [1–13], P=0.01). Logistic regression analysis showed that the time interval from collapse to start of CPR was an independent predictor of ROSB (OR 0.81, 95% CI (0.62–0.97); P=0.05). Thirty two patients were complicated with acute coronary syndrome and 84% among them achieved ROSB. Of the 32 patients, 69% were treated with reperfusion therapy of percutaneous coronary intervention and all of them achieved ROSB.
Conclusion: The time interval from collapse to start of cardiopulmonary resuscitation is a predictor of ROSB in patients treated with ECPR. In patients complicated with acute coronary syndrome, reperfusion therapy with percutaneous coronary intervention is useful in achieving ROSB.