Abstract 12316: Extracorporeal Cardiopulmonary Resuscitation With Cardiac Arrest Bypass System for Refractory Out-of-Hospital Cardiac Arrest is associated With Favorable Survival
Introduction: In a rural region with few medical resources, we have promoted the strategy that, if a refractory out-of-hospital cardiac arrest (OHCA) patient is likely reversible, the patient should be transported directly from the scene to our tertiary-care center where extracorporeal cardiopulmonary resuscitation (ECPR) is readily available (cardiac arrest bypass campaign). We investigated 1-month survival and neurological outcomes after ECPR in OHCA patients at this center.
Methods: We implemented a retrospective review of OHCA patients of heterogeneous origin in whom ECPR was performed in our center. Demographic characteristics, cardiopulmonary resuscitation, ECPR details, and neurological outcomes were evaluated.
Results: Fifty-six patients (male 39, female 17, 52±20 years) with OHCA underwent ECPR between April 2004 and April 2014. Presumed causes of OHCA were cardiac etiology in 36 patients, accidental hypothermia in 8 patients, and other causes in 12 patients. Initial cardiac rhythms on the scene were VF in 42 patients, PEA in 3 patients, and asystole in 11 patients. Of the 56 patients, 16 patients were unwitnessed cardiac arrest (CA), and 20 patients did not have bystander CPR. Overall, 13 patients (23%) survived, and 10 patients (18%) had favorable outcomes with cerebral performance categories score 1. Of the 36 patients with OHCA of cardiac origin, 5 patients (14%) had favorable outcomes. Of the 8 patients with OHCA of hypothermic origin, 5 patients (63%) had favorable outcomes. Although no significant differences were observed in the rates of witnessed CA and bystander CPR between the favorable and the unfavorable outcome group, the favorable outcome group had significantly higher arterial pH on arrival (7.10±0.08 VS 6.89±0.24, P<0.001).
Conclusions: ECPR with CA bypass system can be a useful means to rescue OHCA patients unresponsive to conventional CPR, especially in those of cardiac or hypothermic origin, in a rural tertiary-care center.
Author Disclosures: K. Mochizuki: None. H. Imamura: None.
- © 2014 by American Heart Association, Inc.