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Observational Study
. 2020 Sep 28;15(9):e0239777.
doi: 10.1371/journal.pone.0239777. eCollection 2020.

Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest

L Christian Napp  1 , Carolina Sanchez Martinez  1 , Muharrem Akin  1 , Vera Garcheva  1 , Christian Kühn  2 , Johann Bauersachs  1 , Andreas Schäfer  1
Affiliations
Observational Study

Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest

L Christian Napp et al. PLoS One. .

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) refractory to conventional high-quality cardiopulmonary resuscitation (CPR) may be rescued by extracorporeal CPR (eCPR) using veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Even when trying to identify eCPR candidates based on criteria assumed to be associated with a favourable neurological outcome, reported survival rates are frequently below 10%.

Methods: All patients undergoing implantation of V-A ECMO for eCPR between January 2018 and December 2019 (N = 40) were analysed (age 53±13 years; 75% male). Patients with refractory OHCA and potentially favourable circumstances (initial shockable rhythm, witnessed arrest, bystander CPR, absence of limiting comorbidities, age <75 years) were transported under mechanical chest compression. Candidates for eCPR should have a pH ≥6.9, arterial lactate ≤15 mmol/L and time-to-ECMO should be ≤60 minutes.

Results: Overall 30-day survival was 12.5%, with 3 of 5 survivors having a favourable neurological outcome (cerebral performance category (CPC) 1 or 2), representing 7.5% of the total eCPR population. No patient selected for eCPR met all pre-defined criteria (median of unfavourable criteria: 3). Importantly, time-to-ECMO most often (39/40) exceeded 60 minutes (mean 102 ±32 min.), and lactate was >15mmol/L in 30 out of 40 patients. Moreover, 22 out of 40 patients had a non-shockable rhythm on the first ECG.

Conclusions: Despite our intention to select patients with potentially advantageous circumstances to achieve acceptable eCPR outcomes, the imminent deadly consequence of withholding eCPR obviously prompted individual physicians to perform the procedure also in presumably more unfavourable settings, resulting in similar mortality rates of eCPR as reported before.

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Conflict of interest statement

AS has received lecture and proctoring honoraria from Abiomed and ZOLL, LCN has received lecture honoraria from Maquet, Abbott, Zoll and Orion as well as lecture, consulting and proctoring honoraria from Abiomed. All other authors declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Survival following extracorporeal cardiopulmonary resuscitation (eCPR).
30-day survival on eCPR depending on admission renal function (A), age (B), presence of shockable rhythm (C) or bystander CPR (D).
See this image and copyright information in PMC

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