Extracorporeal cardiopulmonary resuscitation (ECPR) survival: A quaternary center analysis

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue strategy for nonresponders to conventional CPR (CCPR) in cardiac arrest.Definitive guidelines for ECPR deployment do not exist. Prior studies suggest that arrest rhythm and cardiac origin of arrest may be variables used to assess candidacy for ECPR.Aim: To describe a single-center experience with ECPR and to assess associations between survival and physician-adjudicated origin of arrest and arrest rhythm.Methods: A retrospective review of all patients who underwent ECPR at a quaternary care center over a 7-year period was performed. Demographic and clinical characteristics were extracted from the medical record and used to adjudicate the origin of cardiac arrest, etiology, rhythm, survival, and outcomes. Univariate analysis was performed to determine the association of patient and arrest characteristics with survival.Results: Between 2010 and 2017, 47 cardiac arrest patients were initiated on extracorporeal membrane oxygenation (ECMO) at the time of active CPR. ECPR patient survival to hospital discharge was 25.5% (n = 12). Twenty-six patients died on ECMO (55.3%) while nine patients (19.1%) survived decannulation but died before discharge. Neither physician-adjudicated arrest rhythm nor underlying origin were significantly associated with survival to discharge, either alone or in combination. Younger age was significantly associated with survival. Nearly all survivors experienced myocardial recovery and left the hospital with a good neurological status.Conclusions: Arrest rhythm and etiology may be insufficient predictors of survival in ECPR utilization. Further multiinstitutional studies are needed to determine evidenced-based criteria for ECPR deployment.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Categories delineating race or ethnicity varied markedly. Overall, 54 studies (58%) found no statistical association between race and/or ethnicity and outcome (37–76), while 36 (39%) observed adverse outcomes in populations from underrepresented/diverse racial or ethnic backgrounds (Black/African American, Asian, Hispanic, or “other”/“non-Caucasian”/“non-White”). Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses.…”

Traumatic Injuries Following Mechanical versus Manual Chest Compression

“… 9–11 The LUCAS is also amenable for use during coronary catheterization 12 , 13 and during Extracorporeal cardiopulmonary resuscitation (ECPR), a rescue strategy for nonresponders to CPR in cardiac arrest. 13 …”

“…8 Studies of the Lund University Cardiopulmonary Assist System (LUCAS), a type of MPD with a vacuum head, reported improved perfusion to cerebral neurological systems and coronary arteries, achieving high PCO 2 values compared to standard manual compression. [9][10][11] The LUCAS is also amenable for use during coronary catheterization 12,13 and during Extracorporeal cardiopulmonary resuscitation (ECPR), a rescue strategy for nonresponders to CPR in cardiac arrest. 13 With the expanded distribution of ACD devices, investigations of their relative efficacy and safety in patients with OHCA have increased.…”

“…[9][10][11] The LUCAS is also amenable for use during coronary catheterization 12,13 and during Extracorporeal cardiopulmonary resuscitation (ECPR), a rescue strategy for nonresponders to CPR in cardiac arrest. 13 With the expanded distribution of ACD devices, investigations of their relative efficacy and safety in patients with OHCA have increased. Hallstrom and colleagues 14 found no significant difference between the LDB device and manual compression in the percentage of patients who achieved ROSC; indeed, both survival rate and neurological outcomes were lower in the LDB group.…”

The Year 2020 in Review: Coronavirus Disease 2019 Cloud and Its Impact Excelling the Clinical Practice

“…Marinacci et al observed only a 25.5% survival to discharge after ECPR, and that arrest rhythm and etiology seemed to be insufficient predictors of outcome. 25 ECMO is associated with a high rate of neurologic injury, which could be a hemorrhagic stroke or anoxic injury during the cardiac arrest. 26 One way to mitigate the hemorrhagic injury is ideal anticoagulation.…”