ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years

Abstract

Background: Use of Extracorporeal Membrane Oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being deployed as an adjunct to conventional CPR. It is unknown if this has been associated with improved outcomes.

Aims: To describe trends in survival and patient demographics for ECPR patients in the international Extracorporeal Life Support Organisation (ELSO) database over the past 12 years and identify factors associated with changes in survival.

Methods: Patients greater than 16 years of age who received ECPR between January 2003 and December 2014 were extracted from the ELSO registry and were divided into three 4-year cohorts (Cohort 1: 2003-2006, Cohort 2: 2007-2010, Cohort 3: 2011-2014). Univariable analysis was performed to compare demographics and outcomes of patients across the three cohorts. Univariable and multivariable analyses were then performed to identify factors independently associated with survival.

Results: 1796 patients treated with ECPR were extracted from the registry, aged 50 (±18.5) years. Annual ECPR episodes increased over 10-fold, from 35 to over 400 per year. Survival to hospital discharge was 29% overall (27% cohort 1, 28% cohort 2, 30% cohort 3 (p=0.71)). Age, body weight and documented comorbidities increased over time. There was a reduction in complications associated with ECMO usage. After adjusting for confounders there was no change in the odds of survival over the time period examined.

Interpretation: Over the period 2003-2014, survival to hospital discharge was 29% for patients who require ECPR. Despite advances in provision of ECMO care and increasing co-morbidities of patients, there has been no change in risk-adjusted survival over time.

Keywords: CPR; Cardio Pulmonary Resuscitation; ECMO; ECMO-CPR; ECPR; ELSO; Extra Corporeal Membrane Oxygenation (ECMO); Extra-Corporeal Membrane Oxygenation; Extra-Corporeal Membrane Oxygenation assisted Cardio Pulmonary Resuscitation; Extracorporeal Life Support Organisation; SAVE score; VA; VV; survival after VA-ECMO score; veno-arterial; veno-venous.