Extracorporeal life support in patients with in-hospital cardiac arrest

Abstract

Background: Cardiopulmonary resuscitation (CPR) is associated with low success rates and high variability in outcomes. Extracorporeal life support (ECLS) systems provide sufficient perfusion of vital organs during treatment of the cardiac arrest (CA) cause. The routine use of ECLS is still under investigation. This study aimed to identify predictors of mortality in patients with in-hospital cardiac arrest (IHCA) undergoing ECLS treatment. Method: We retrospectively studied the characteristics and clinical outcomes of 48 patients with IHCA and veno-arterial ECLS treatment during on-going CPR treated between January 2009 and December 2012. Left ventricular ejection fraction (LVEF) and laboratory measurements were analysed. LVEF at baseline was taken from the medical report before CA and was further evaluated after ECLS implantation and then every 24 h during and after successful weaning from ECLS. Survival was determined from time of cardiac arrest to 30 days. Results: The 30-day survival rate was 31.3% (15 of 48 patients). Baseline characteristics, initial laboratory measurements, baseline LVEF as well as LVEF after ECLS treatment were not significantly different between survivors and non-survivors. There was no difference regarding median CPR duration (survivors 40.5 min [IQR 18.8-51.5] vs. non-survivors 31.0 min [IQR 20.0-49.0]; P=0.80) and duration of ECLS system implantation time (survivors 21.0 min [IQR 10.0-29.5] vs. non-survivors 15.0 min [IQR 9.5-22.5]; P=0.39). The interval between CA and start of ECLS system set up did not show a significant difference among the groups (survivor 21.5 min [IQR 10.0-32.3] vs. non-survivor 17.5 min [IQR 5.0-30.0]; P=0.56). ECLS treatment duration was not significantly different between the two groups (survivors: 69.0 hours [IQR 21.0–178.0] vs. non-survivors 39.0 hours [IQR 5.0–129.0]; P=0.24). Conclusion: In prolonged IHCA with failing conventional measures rapid initiation of an adequate organ perfusion by means of ECLS may help to improve the outcome.