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Extracorporeal cardiopulmonary resuscitation (ECPR) survival: A quaternary center analysis
Author(s) -
Marinacci Lucas X.,
Mihatov Nino,
D'Alessandro David A.,
Villavicencio Mauricio A.,
Roy Nathalie,
Raz Yuval,
Thomas Sunu S.
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15550
Subject(s) - extracorporeal cardiopulmonary resuscitation , medicine , extracorporeal membrane oxygenation , cardiopulmonary resuscitation , etiology , retrospective cohort study , resuscitation , emergency medicine , cardiology
Background Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue strategy for nonresponders 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 the origin of cardiac arrest, etiology, rhythm, survival, and outcomes. Univariate analysis was performed to determine the 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 nine patients (19.1%) survived decannulation but died before 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 multiinstitutional studies are needed to determine evidenced‐based criteria for ECPR deployment.