Abstract 120: Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest Is Associated with Favorable Survival: Possible Indications
Background: Several recent studies reported better neurological prognosis in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OHCA). However, the indication of this procedure is still unknown.
Method: Forty-three patients (male 27, female 16, 51±22 years, including 4 pediatric patients) with refractory OHCA who underwent ECPR between April 2004 and March 2012 in our center were retrospectively investigated.
Results: Seventy-four percent of patients were witnessed, 58% underwent bystander CPR. Presumed causes of OHCA were acute coronary syndrome in 35%, primary electrical disorder in 14%, Myocardial disease in 12%, accidental hypothermia in 14%, hypothermia with suffocation or drowning in 12%, others (pulmonary embolism, acute aortic dissection, intracranial hemorrhage and toxicosis) in 14%. Initial cardiac rhythms were VF/pulseless VT, PEA, and asystole in 72%, 7%, and 21% of patients, respectively. Median time to ECPR initiation from collapse and from admission were 80 minutes and 31 minutes, respectively. Complications related to ECPR were found in 7% of patients (retroperitoneal hemorrhage and aortic dissection). Rates of return of spontaneous circulation, survival to discharge, and good neurological recovery were 77%, 26%, and 21%, respectively. All patients with good neurological recovery (Recovery group) had VF as initial cardiac rhythm, and had cardiac etiology or accidental hypothermia. Patients in the Recovery group had higher blood pH on admission than others (7.10±0.09 vs 6.88±0.26, P<0.05). In the Recovery group, time from collapse to ECPR initiation of all adult patients with cardiac etiology was within 60 (38±6) minutes without exception. On the other hand, that of hypothermic or pediatric patients was over 60 (107±42) minutes.
Conclusions: ECPR should be considered for OHCA patients refractory to conventional advanced life support. Possible indications for ECPR are shock-resistant VF patients with heart diseases or accidental hypothermia, blood pH>6.9 on admission, and pediatric patients.
- © 2012 by American Heart Association, Inc.