CPR-ECMO for In-Hospital Cardiac Arrest: What are the Predictive Factors for Survival and are We Missing Anyone?

Abstract

Introduction: While it is well established that extracorporeal membrane oxygenation (ECMO) can improve the probability of survival in some in-hospital cardiac arrest (IHCA) patients for whom prolonged conventional cardiopulmonary resuscitation (C-CPR) is futile, the predictive factors for survival with this approach (CPR-ECMO) are incompletely defined. We examined a single institution's experience with CPR-ECMO and IHCA with the aim of identifying outcome predictors. We also investigated whether any patients who died after receiving C-CPR only, should have been considered for CPR-ECMO. Methods: We retrospectively examined the medical records of 20 adult IHCA patients who required CPR-ECMO and 43 adult IHCA patients who died after receiving C-CPR only, during 2009–2011. Pre-arrest and arrest details were analysed. Results: In the CPR-ECMO group survival to hospital discharge was 67%. Reversible cause of cardiac arrest, and cardiac arrest during regular working hours in a monitored environment were correlated with improved survival. The relationship between survival and C-CPR duration prior to CPR-ECMO, as well as the relationship between survival and age were less conclusive. Seven out of forty-three (16%) IHCA patients who died after receiving C-CPR only were identified as potential CPR-ECMO cases. Conclusions: CPR-ECMO can be used successfully in some IHCA patients. Our study has a highly select group of patients and based on our investigation into IHCA patients who were not considered for CPR-ECMO and died we identified seven potential CPR-ECMO cases. A prospective, multicentre trial is needed to better identify predictors for survival and to improve recognition of IHCA patients suitable for CPR-ECMO.