Abstract 271: Outcomes of Extracorporeal Membrane Oxygenation in Adult Patients With Refractory Shock and Cardiac Arrest
Introduction: Extracorporeal membrane oxygenation (ECMO) could rapidly provide temporary circulatory assistance for patients complicated with shock or cardiac arrest. However, the relation between effectiveness of ECMO and the status of patients is still unclear.
Hypothesis: We assessed the hypothesis that the outcomes of adult patients treated with ECMO are worse in patients with cardiac arrest than in those without cardiac arrest.
Methods: We conducted a retrospective study at 2 regional tertiary care centres. We divided the study patients into 2 groups on the basis of more than 1 occurrence of cardiac arrest (CPA group) or absence of cardiac arrest (non-CPA group) before the initiation of ECMO. We assessed weaning from ECMO, 30-day survival, and favourable neurological findings and constructed 365-day survival curves by using the Kaplan-Meier method.
Results: Of the 103 adult patients enrolled, 11 (11%) were assigned to the CPA group. There was no significant difference regarding baseline characteristics such as age and sex. The incidence of acute coronary syndrome was significantly higher (57% vs. 18%, P = 0.02) and that of myocarditis was significantly lower (3% vs. 46%, P <0.01) in the CPA group than in the non-CPA group. The rates of weaning from ECMO (91% vs. 49%, P < 0.01), 30-day survival (82% vs. 26%, P < 0.01), and favourable neurological findings (64% vs. 19%, P < 0.01) were higher in the CPA group than in the non-CPA group. Survival analysis revealed a lower 365-day survival in the CPA group (log-rank P = 0.001). Stepwise Cox proportional hazard regression analysis revealed that age (OR 1.02, 95%CI 1.00–1.04; P = 0.03), diagnosis of acute coronary syndrome (OR 1.38, 95%CI 1.06–1.78), and the presence of cardiac arrest before ECMO (OR 0.35, 95%CI 0.16–0.62) were independent predictors of 365-day survival.
Conclusions: Presence of cardiac arrest before ECMO leads to adverse outcomes in adult patients treated with ECMO. Early circulatory support with ECMO before cardiac arrest may be useful in patients complicated with shock.
- © 2010 by American Heart Association, Inc.