Abstract 93: Ecmo as Rescue Strategy for Refractory Cardiac Arrest and Profound Shock
Background: Extracorporeal Membrane Oxygenation (ECMO) has been trialed as a rescue strategy for patients with refractory cardiac arrest unresponsive to conventional cardiopulmonary resuscitation or profound shock unresponsive to vasopressors and inotropes.
Objective: We sought to describe our institution’s experience with implementation of ECMO for Emergency Department (ED) and inpatient cardiac arrests and cases of profound shock. Main variables were whether a patient was in cardiac arrest or profound shock, location of patient at time of initiation of ECMO, and our primary outcome was survival to hospital discharge.
Methods: Consecutive patients placed on ECMO for the above indications were enrolled at two urban academic medical centers from July 2007 - February 2012.
Results: During the study period, 44 patients were included. Average age was 44.6 years, 70% were male, 55% were white, and 77% of patients suffered from cardiac arrest. Among cardiac arrest patients, initial rhythms were ventricular fibrillation or ventricular tachycardia in 45%. Fourteen patients (32%) were cannulated in the ED. The average time from arrest to initiation of ECMO was 46 minutes (range 0.33-3.17 hours). Twenty-four patients (54%) had complications related to ECMO, which were most commonly bleeding and ischemic events. Eleven patients (25%) survived to discharge, of which 9 (20%) were neurologically intact (Glasgow Coma Scale Score of 15) at 6 months.
Conclusion: In this US case series, ECMO shows promise as a rescue strategy for refractory arrest and profound shock. Further investigations are necessary to refine the technique, patient selection, and ancillary therapeutics.
- Cardiac arrest
- Extracorporeal circulation
- Ventricular fibrillation
- Ventricular tachycardia
- Emergency care
- © 2013 by American Heart Association, Inc.