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. 2019 Apr;42(4):459-466.
doi: 10.1002/clc.23169. Epub 2019 Mar 18.

Experience of extracorporeal cardiopulmonary resuscitation in a refractory cardiac arrest patient at the emergency department

Kap Su Han  1 , Su Jin Kim  1 , Eui Jung Lee  1 , Jae Seung Jung  2 , Jae Hyoung Park  3 , Sung Woo Lee  1
Affiliations

Experience of extracorporeal cardiopulmonary resuscitation in a refractory cardiac arrest patient at the emergency department

Kap Su Han et al. Clin Cardiol. 2019 Apr.

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a method to improve survival outcomes in refractory cardiac arrest.

Hypothesis: This study aimed to determine the associated factors related to outcome and to analyze the post-ECPR management in patients who received ECPR due to nonresponse to advanced cardiac life support (ACLS).

Methods: This was a retrospective analysis based on a prospective cohort. Cardiac arrest patients who received ECPR in our emergency department from May 2006 to December 2017 were selected from the prospective cohort. Patients who received ECPR for rearrest were excluded. The primary outcome was survival to discharge.

Results: ECPR was attempted in 100 patients who did not respond to ACLS. Fourteen patients survived to discharge, and 12 (85.7%) patients showed good neurologic outcomes. The rate of survival to discharge decreased according to increasing age and ACLS duration. Age, presence of any return of spontaneous circulation (ROSC) during ACLS, and prolongation of ACLS were associated factors for survival discharge in ECPR patients. Fourteen patients required distal perfusion catheters, and 35 patients received continuous renal replacement therapy (CRRT). The proportion of death was the highest within 24 hours after ECPR as 57.0%.

Conclusions: The early transition from ACLS to ECPR may improve the ECPR outcomes. In addition, good outcomes are expected for ECPR performed after refractory arrest if the patient is young and experiences an ROSC event during ACLS. In post ECPR management, the majority of mortality events were occurred in the early period, and distal perfusion catheter and CRRT were frequently required.

Keywords: advanced cardiac life support; emergency department; extracorporeal cardiopulmonary resuscitation; refractory cardiac arrest.

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Conflict of interest statement

Authors' contributions

K.S.H., S.J.K., and S.W.L. conceived the study design and wrote the manuscript. E.J.L., J.S.J., J.H.P., J.S.P., and K.S.H. were responsible for patient care and helped conduct the trial and data collection. K.S.H. and S.W.L. managed and analyzed the data, including quality control. All authors contributed substantially to the revision of the manuscript.

Figures

Figure 1
Figure 1
Selection of study patients and outcomes. Rearrest was defined as recurrent cardiac arrest within 24 hours after survival event (sustained return of spontaneous circulation >20 minutes). Refractory arrest was defined as the nonachievement of survival event within 30 minutes of advanced cardiac life support. Successful commencement of ECPR implies that spontaneous heart beating was obtained under the support of ECPR. Successful weaning from ECPR was defined as survival to 24 hours after weaning of ECPR. ED, emergency department; OHCA, out‐of‐hospital cardiac arrest; CPR, cardiopulmonary resuscitation; ECPR, extracorporeal CPR; CPC, cerebral performance category
Figure 2
Figure 2
Time phase of mortality in patients who received extracorporeal cardiopulmonary resuscitation (ECPR). Of the total 86 nonsurvivors, 57% of mortality occurred within 24 hours post ECPR implementation, 19.8% from 24 hours to 48 hours, 15.1% from 48 hours to 72 hours, and 8.1% after 72 hours (P < 0.001)
Figure 3
Figure 3
Mean arterial pressure (MAP) and serum lactate level of survivors and non‐survivors according time. MAP was significantly higher in the survivors than in the nonsurvivors at 2, 6, and 24 hours post ECPR implementation. Serum lactate level was significantly lower in the survivors than in the nonsurvivors group at 24 hours post ECPR implementation. The serum lactate level tended to decrease rapidly in the surviving group. * P < 0.05. ECPR, extracorporeal cardiopulmonary resuscitation
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