Application of extracorporeal cardiopulmonary resuscitation in refractory in-hospital cardiac arrest in adults

Abstract

Objective To identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on survival and neurologic outcome in adults with refractory in-hospital cardiac arrest (IHCA). Methods All 74 adult patients who underwent ECPR for IHCA were enroued from July 2012 to December 2017 in Beiing Anzhen Hospital, Capital Medical University. Survival to discharge and cerebral performance category (CPC) scale were evaluated. The independent high-risk factors were determined using multivariate regression analysis models. Results Patients were discharged alive with favorable neurologic outcomes (CPC 1-2). Compared with patients in the SG group, the value of blood gas pH and extracellular residual alkaloids in the DG group were statistically lower (with P values below 0.05). The incidence of renal function failure requiring continuous renal replacement treatment (CRRT) and severe neurological complications were statistically higher in DG group patients. Multivariate regression analysis suggested that advanced age (age≥65 years), renal function failure requiring CRRT, and severe neurological complications were independent high-risk factors for hospital death. Conclusions ECMO can provide stable hemodynamic support to in-hospital cardiac arrest patients and save the lives of some patients. ECMO should be actively implanted when the cause of cardiac arrest is expected to be recoverable. Key words: Extracorporeal membrane oxygenation; Cardiopulmonary resuscitation; Treatment outcome; In-hospital cardiac arrest