Abstract
BackgroundRefractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution.MethodsThis is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model.ResultsThe overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flow Time, cardiac arrest Location, and initial cardiac arrest Rhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%, p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%, p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%, p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%, p = 0.0003) than the medium-risk and high-risk groups.ConclusionsPatients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.
Highlights
Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-Cardiopulmonary resuscitation (CPR)) has a poor outcome
We aimed to review the clinical outcomes of patients in our institution with refractory cardiac arrest receiving extracorporeal cardiopulmonary resuscitation (E-CPR) and identify potentially useful clinical parameters before extracorporeal membrane oxygenation (ECMO) therapy initiation to predict patient outcome in this challenging condition
We enrolled patients who fulfilled the following criteria for the E-CPR program: age 18–75 years; cardiac arrest presumed to be of cardiac origin; conventional cardiopulmonary resuscitation (C-CPR) initiated for cardiac arrest within 5 min; and refractory cardiac arrest defined as failure to achieve return of spontaneous circulation (ROSC) after at least 10 min of C-CPR
Summary
Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Laboratory data and etiology of cardiac arrest are often unknown prior to E-CPR use Using such prognostic scores is complex and requires clinical information that is typically only available after ECMO use. Prognostic factors, such as low-flow time and cardiac rhythm, were found to be related to survival and neurological outcome in patients with in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) who received E-CPR [21,22,23]. We aimed to review the clinical outcomes of patients in our institution with refractory cardiac arrest receiving E-CPR and identify potentially useful clinical parameters before ECMO therapy initiation to predict patient outcome in this challenging condition
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