Abstract 141: Effects of Temporary Return of Spontaneous Circulation Before Start of Extracorporeal Circulation on Outcomes in Patients Treated With Extracorporeal Cardiopulmonary Resuscitation
Introduction: Cardiopulmonary resuscitation with emergency cardiopulmonary bypass (ECPR) may provide better outcomes in cardiac arrest patients. In our experience, some patients achieved temporary return of spontaneous circulation (ROSC) before the start of cardiopulmonary bypass (CPB), but clinical implications of temporary ROSC remain unclear.
Hypothesis: We tested the hypothesis that temporary ROSC before the start of CPB results in better outcomes in cardiac arrest patients treated with ECPR.
Methods: We conducted a retrospective study at 2 regional tertiary care centres. The study patients were divided into 2 groups: 1) patients in whom the carotid artery was palpated more than once without chest compression (preROSC-group) and 2) those in whom the carotid artery was not palpate (nonROSC-group) before CPB. We assessed weaning from CPB, 30-day survival, and favourable neurological findings; further, we constructed 365-day survival curves with the Kaplan-Meier method.
Results: Of the 54 patients enrolled, 27 were assigned to the preROSC-group. There was no significant difference regarding baseline characteristics such as age, sex, initial recorded rhythm, by-stander chest compression, and diagnosis. Although the time interval from collapse to the start of CPB tended to be longer for the preROSC-group than for the nonROSC-group, the difference was insignificant (median (IQR) = 53 (40–66) vs. 40 (25–53) min; P=0.06). The rate of weaning from CPB was higher among the preROSC-group than among the nonROSC-group (75% vs. 41% P=0.01). The rate of 30-day survival (33% vs. 19%, P=0.21) and the favourable neurological findings did not significantly differ between the 2 groups (27% vs. 15%, P=0.28). Survival analysis revealed a better 365-day survival among the preROSC-group (log-rank P=0.01). Stepwise Cox proportional hazard regression analysis revealed temporary ROSC achieved before the start of CPB to be an independent predictor of better 365-day survival (OR 1.56 (95%CI 1.10–2.26); P=0.01).
Conclusions: Temporary ROSC before the start of CPB provides better outcomes in cardiac arrest patients treated with ECPR.
- © 2010 by American Heart Association, Inc.