Abstract 14505: Determinants of Stabilization for Out-of-Hospital Cardiac Arrest Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation

Abstract

Introduction: Sudden cardiac arrest causes approximately 400,000 deaths in the United States per year. Extracorporeal membrane oxygenation (ECMO), in conjunction with coronary interventions, was shown to improve survival for patients with refractory shockable rhythms in the ARREST trial. However, it remains unclear which parts of the protocol are critical for hemodynamic stabilization in these patients. Therefore, this study aims to assess patient status through each step of the ARREST trial protocol. Methods: Retrospective assessment was performed in 185 adults with refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest transported for ECPR. Continuous variables were compared using parametric or non-parametric testing when normality was not met. Chi-square was used to compare categorical values and linear regression models to compare associations between survival and angiographic characteristics. Results: Distribution data showed 32% of patients achieved ROSC prior to extracorporeal membrane oxygenation or coronary intervention, though they had ongoing cardiogenic shock. ECMO provided hemodynamic stabilization with an organized cardiac rhythm in 31% of patients prior to coronary intervention. ECMO and coronary revascularization was required for hemodynamic stabilization and development of an organized cardiac rhythm in 30% of patients. The remaining 7% of patients failed to achieve ROSC despite ECMO, revascularization, and medical therapy. The angiographic profile from each of these groups was evaluated and showed that 63% of all patients had obstructive CAD including 48% of patients that arrived with ROSC and cardiogenic shock, 71% of patients that stabilized with ECMO alone, and 100% of patients that achieved ROSC after coronary interventions (p<0.01). Conclusions: Coronary revascularization is not required for stabilization of most patients. However, the impact of coronary artery disease on recovery potential is not known.