Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

Abstract

Aim Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy for refractory cardiac arrest. The purpose of this study was to analyze and report characteristics and outcomes of adult patients treated with ECPR after out-of-hospital cardiac arrest (OHCA) in a large international registry. Methods The Extracorporeal Life Support Organization’s Extracorporeal Life Support Registry was queried for adult cardiac arrests with arrest location of “EMT Transport” or “Outside Hospital.” Results From 2010–2016, 217 cases of ECPR following OHCA were reported in Europe (47%), Asia-Pacific (29%), and North America (24%). The median age was 52 years (IQR 45–62, range 18–87); 73% were male. The median duration of ECPR was 47 h (IQR 17–94, range 0–711). Reported complications included hemorrhage (31.3%), limb complications (11.1%), circuit complications (8.8%), infection (7.4%), and seizures (5.5%). The rate of percutaneous coronary intervention (PCI) was higher in Europe (35.6%) and Asia-Pacific (25.8%) than North America (9.4%; p < 0.01). Survival to hospital discharge was 27.6% (95% CI 22.1–34.0%), and male gender was independently associated with mortality (adjusted odds ratio 2.1 [95% CI 1.1–4.2], p < 0.05). Survival did not differ by region, race, age, or year. Brain death was reported in 16.6% [95% CI 12.2–22.1%]; organ donation rate was not reported. Conclusion This international analysis of ECPR for refractory OHCA reveals a survival rate of 27.6%, demonstrates association of male gender with mortality, and highlights regional differences in PCI utilization. These results will help inform implementation and research of this potentially life-saving strategy for refractory OHCA.

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

“…Elderly patients aged > 65 years accounted for 29.4% of all ECPR cases in the present study, which was similar to ELSO registry data [11], but the percentage was considerably lower than the traditional CPR registry data of 60–70% [10, 32, 34]. This indicates that clinical discretion during CPR consultation favors young patients for ECMO support.…”

“…The number of elderly patients being referred for ECMO support when undergoing CPR has increased in recent years [7–10]. Although “age” has not been indicated to have a negative linear correlation with hospital survival in patients with ECPR [7, 11], the Good Outcome Following Attempted Resuscitation score [12] for CPR and the survival after veno-arterial-ECMO (SAVE) score [13] for ECMO both indicate that old age is a risk factor for poor hospital outcomes. The present study evaluated whether advanced old age (> 75 years) is a contraindication for ECPR regarding hospital outcome, with a particular focus on the effect of interplay between old age and prolonged LFDs.…”

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*

“…The interaction of cannulation site with neurologic injury was not delineated in this report. Although we may consider translating data gathered from the increasing adult E-CPR experience (2, 41–43), the high frequency of femoral cannulation and rare use of central/carotid cannulation limit our ability to make associations with mortality or neurologic outcomes.…”

Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR)

“…Zudem ist zu berücksichtigen, dass ältere und gebrechliche Patienten mit OHCA eine niedrige Überlebenswahrscheinlichkeit zeigen [41]. Das Alter alleine scheint dennoch die Überlebensrate nicht negativ zu beeinflussen und sollte daher nicht als absolute Kontraindikation aufgeführt werden [22,42,43]. Zusammenfassend existieren aus Beobachtungsstudien eine Reihe von Parametern mit prognostischer Bedeutung, wobei keiner dieser Marker im Sinne einer "No-go-Entscheidungshilfe" herangezogen werden kann.…”

“…B. Myokardinfarkt oder Lungenarterienembolie; [10][11][12]). Beobachtungsstudien deuten darauf, dass die eCPR bei diesen selektierten IHCA-und OHCAPatienten im Vergleich mit der konventionellen CPR mit einer Zunahme der Überlebensrate von bis zu 30 % einhergeht [4,[13][14][15][16][17][18][19][20][21][22]. In einer Metaanalyse zeigte sich eine um 13 % verbesserte Überlebenswahrscheinlichkeit im Vergleich zur konventionellen CPR (95 %-Konfidenzintervall [95 %-KI] 6-20 %; p < 0,001; "number needed to treat" 7,7; [23] …”