Abstract 116: Door-to-Implantation Time of Percutaneous Circulatory Support Systems Predicts Mortality in Patients with Out-of-Hospital Cardiac Arrest
Background: Cardiopulmonary resuscitation (CPR) is associated with low success rates and high variability in outcomes. Extracorporeal life support systems (ECLS) provide hemodynamic stabilization and can be implanted under ongoing CPR. The routine use of ECLS during CPR is still under discussion. The aim of the present study was to identify predictors of mortality in patients suffered from out of hospital cardiac arrest (OHCA) undergoing in-hospital ECLS treatment.
Methods: We retrospectively studied the characteristics and clinical outcome of 29 patients with OHCA and veno-arterial ECLS set up during ongoing CPR upon admission to the cath lab. Survival was determined from the time of admission to death or to 30 days. Laboratory measurements and determination of left ventricular ejection fraction (LVEF) were analysed.
Results: The 30 day survival rate was 37.9% (11 out of 29 patients). There were no differences in baseline characteristics, initial laboratory measurements and LVEF (survivors: 31.8±18.1 vs. non-survivors: 23.8±19.1%; P=0.32) determination between survivors and non-survivors. The CPR duration was at median 44.0 min (IQR 31.0-45.0) in the survivor group and 53.0 min (IQR 40.0-61.3) in the non-survivor group (P=0.23). Door to ECLS implantation time was significant longer in the non-survivor group (42.5 min IQR (28.0-56.5) vs. 25.0 min IQR (21.0-30.0); P<0.01). There was no difference regarding ECLS treatment duration between the two groups (survivors: 4.0 days IQR (1.5-7.5) vs. non-survivors 6.5 days IQR (1.0-8.0); P=0.69). LVEF improved after ECLS implantation only in patients who survived the 30-day period (mean±SD 47.5±14.7% vs. 23.3±14.9%; P<0.01). Kaplan-Meier survival analysis (Log Rank 6.29; P=0.01) and Cox regression analysis (HR 4.25; 95% CI 1.21-14.9; P=0.02) revealed that the difference in 30 day mortality was restricted to door to ECLS implantation with a cut-off of 30 minutes.
Conclusion: A door to ECLS implantation time of less than 30 minutes seems to have beneficial effects on LVEF recovery and improve 30 days outcome in patients with OHCA.
- Cardiac arrest
- Cardiopulmonary resuscitation
- Extracorporeal circulation
- Assisted circulation
- © 2012 by American Heart Association, Inc.