Clinical Significance of Low-Flow Time in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: Results from the RESCUE Registry.

Ik Hyun Park,Woo Jin Jang,Hyun Jong Lee,Woo Jung Chun,Yong Hwan Park,Ju Hyeon Oh,Jin-Ok Jeong,Bum Sung Kim,Cheol Woong Yu,Hyun-Joong Kim,Hyeon-Cheol Gwon,Jeong Hoon Yang

doi:10.3390/jcm9113588

Abstract

Limited data are available on the association between low-flow time and survival in patients with in-hospital cardiac arrest (IHCA) who undergo extracorporeal cardiopulmonary resuscitation (ECPR). We evaluated data from 183 IHCA patients who underwent ECPR as a rescue procedure. Patients were divided into two groups: patients undergoing extracorporeal membrane oxygenation as an adjunct to standard cardiopulmonary resuscitation for less than 38 min (n = 110) or for longer than 38 min (n = 73). The ECPR ≤ 38 min group had a significantly greater incidence of survival to discharge compared to the ECPR > 38 min group (40.0% versus 24.7%, p = 0.032). The incidence of good neurologic outcomes at discharge tended to be greater in the ECPR ≤ 38 min group than in the ECPR > 38 min group (35.5% versus 24.7%, p = 0.102). The incidences of limb ischemia (p = 0.354) and stroke (p = 0.805) were similar between the two groups, but major bleeding occurred less frequently in the ECPR ≤ 38 min group compared to the ECPR > 38 min group (p = 0.002). Low-flow time ≤ 38 min may reduce the risk of mortality and fatal neurologic damage and could be a measure of optimal management in patients with IHCA.

Highlights

Several observational studies have shown that extracorporeal cardiopulmonary resuscitation (ECPR) improves survival compared to conventional cardiopulmonary resuscitation (CPR) in patients with cardiac arrest [1,2,3]
We evaluated the association of ECPR time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) pump-on with in-hospital mortality and good neurologic status and sought to determine the optimal timing of ECMO insertion during standard CPR in cardiogenic shock patients presenting with in-hospital cardiac arrest (IHCA)
Age tended be older in the ECPR > 38 min group compared to the ECPR ≤ 38 min group (p = 0.087), and the incidence of previous myocardial infarction (MI) was significantly higher in the ECPR > 38 min group compared to the ECPR ≤ 38 min group (p = 0.045)

Summary

Introduction

Several observational studies have shown that extracorporeal cardiopulmonary resuscitation (ECPR) improves survival compared to conventional cardiopulmonary resuscitation (CPR) in patients with cardiac arrest [1,2,3]. Previous studies demonstrated acceptable survival after ECPR in patients with in-hospital cardiac arrest (IHCA) [1,5] and suggested that the time from arrest to extracorporeal membrane oxygenation (ECMO) might be the primary determinant of successful outcomes [6,7]. Patients rescued by ECPR within 60 min frequently had poor neurologic outcomes.

Results

Discussion

Conclusion