Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience

Mark Dennis; Peter McCanny; Mario D'Souza; Paul Forrest; Brian Burns; David A Lowe; David Gattas; Sean Scott; Paul Bannon; Emily Granger; Roger Pye; Richard Totaro; Sydney ECMO Research Interest Group

doi:10.1016/j.ijcard.2016.12.003

Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience

Int J Cardiol. 2017 Mar 15:231:131-136. doi: 10.1016/j.ijcard.2016.12.003. Epub 2016 Dec 6.

Authors

Affiliations

¹ Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: mden5273@uni.sydney.edu.au.
² Department of Intensive Care, St Vincent's Hospital, Sydney, Australia.
³ Sydney Local Health District, Clinical Research Centre, Australia.
⁴ Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiothoracic Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Sydney Medical School, University of Sydney, Sydney, Australia; Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance Service, Australia.
⁶ Sydney Medical School, University of Sydney, Sydney, Australia; Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia.
⁷ Department of Emergency Medicine, St Vincent's Hospital, Sydney, Australia.
⁸ Sydney Medical School, University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁹ Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia.

PMID: 27986281
DOI: 10.1016/j.ijcard.2016.12.003

Abstract

Aim: To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications.

Methods: Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres in Sydney, Australia.

Measurements and main results: Thirty-seven patients underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age was 54 (IQR 47-58), 27 (73%) were male. Initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 20 patients (54%), pulseless electrical activity (n=14, 38%), and asystole (n=3, 8%). 27 (73%) arrests were witnessed and 30 (81%) patients received bystander CPR. Median time from arrest to initiation of ECMO flow was 45min (IQR 30-70), and the median time on ECMO was 3days (IQR 1-6). Angiography was performed in 54% of patients, and 27% required subsequent coronary intervention (stenting or balloon angioplasty 24%). A total of 13 patients (35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All survivors were discharged with favourable neurological outcome (Cerebral Performance Category 1 or 2). Pre-ECMO lactate level was predictive of mortality OR 1.35 (1.06-1.73, p=0.016).

Conclusions: In selected patients with refractory cardiac arrest, ECPR may provide temporary support as a bridge to intervention or recovery. We report favourable survival and neurological outcomes in one third of patients and pre-ECMO lactate levels predictive of mortality. Further studies are required to determine optimum selection criteria for ECPR.

Keywords: CPR; Cardiac arrest; Cardiopulmonary resuscitation; ECLS; ECMO; ECPR; ELS; Extracorporeal membrane oxygenation.

Publication types

Multicenter Study
Observational Study

MeSH terms

Australia / epidemiology
Cardiopulmonary Resuscitation / methods*
Extracorporeal Membrane Oxygenation / methods*
Female
Follow-Up Studies
Heart Arrest / mortality
Heart Arrest / therapy*
Humans
Male
Middle Aged
Retrospective Studies
Survival Rate / trends