Extracorporeal cardiopulmonary resuscitation for refractory in-hospital cardiac arrest

Abstract

Despite recent improvement in cardiac arrest management, in-hospital cardiac arrest (IHCA) remains associated with poor outcome. Whereas its usefulness for out-of-hospital cardiac arrest seems poor, extracorporeal cardiopulmonary resuscitation (e-CPR; i.e. veno-arterial extracorporeal membrane oxygenation (VA-ECMO) under cardiopulmonary resuscitation) could be a life-saving strategy for refractory IHCA. To describe the characteristics and outcomes of refractory IHCA patients supported by e-CPR in our institution. Retrospective cohort study of data prospectively collected. All patients implanted with a VA-ECMO for refractory IHCA from 2007 to 2017 were included. VA-ECMO was implanted at the cardiac arrest site by trained cardiac surgeons from our mobile circulatory assistance unit. After ECMO implantation, patients were all referred and managed in our ICU. A 1-yr follow-up phone call was given to each survivor. During the study period, 97 patients (mean age 50.9 ± 14.8 yrs) received e-CPR for refractory IHCA. 80.4% of IHCA had a cardiac origin. VA-ECMO was implanted in our ICU for 37% of them, in the cardiology department for 30%, in another hospital for 23%. Survival rate was 19.6% at hospital discharge, 15% at 1-yr follow-up, with a 1-yr CPC score of 1 [1–2]. Main causes of in-ICU deaths were multiple organ failure (71%) and post-anoxic encephalopathy (12%). Compared to 1-yr non-survivors, 1-yr survivors had similar no- and low-flow, their initial rhythm was more frequently shockable (69.2% versus 33.8%, respectively, P = 0.03) and their day-1 SOFA score was significantly lower (13 [10–14] versus 15 [12–17], respectively, P = 0.02). e-CPR in refractory IHCA is associated with a 15% 1-yr survival rate. Survivors have a good 1-year CPC score. Next step is to determine prognosis factors to select the patients the most likely to benefit from this technique.