Extracorporeal Cardiopulmonary Resuscitation (ECPR) Survival: A
Quaternary Center Analysis
Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has
emerged as a rescue strategy for non-responders 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 origin of cardiac arrest, etiology,
rhythm, survival, and outcomes. Univariate analysis was performed to
determine 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 9 patients
(19.1%) survived decannulation but died prior to 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 multi-institutional studies are needed to determine evidenced
based criteria for ECPR deployment.