Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is a last resort treatment option for refractory cardiac arrest performed in specialized centers. Following consensus recommendations, ECPR is mostly offered to younger patients with witnessed collapse but without return of spontaneous circulation (ROSC). We report findings from a large single-center registry with 252 all-comers who received ECPR from 2011–2019. It took a median of 52 min to establish stable circulation by ECPR. Eighty-five percent of 112 patients with out-of-hospital cardiac arrest (OHCA) underwent coronary angiography, revealing myocardial infarction (MI) type 1 with atherothrombotic vessel obstruction in 70 patients (63% of all OHCA patients, 74% of OHCA patients undergoing coronary angiography). Sixty-six percent of 140 patients with intra-hospital cardiac arrest (IHCA) underwent coronary angiography, which showed MI type 1 in 77 patients (55% of all IHCA patients, 83% of IHCA patients undergoing coronary angiography). These results suggest that MI type 1 is a frequent finding and - most likely - cause of cardiac arrest (CA) in patients without ROSC, especially in OHCA. Hospital survival rates were 30% and 29% in patients with OHCA and IHCA, respectively. According to these findings, rapid coronary angiography may be advisable in patients with OHCA receiving ECPR without obvious non-cardiac cause of arrest, irrespective of electrocardiogram analysis. Almost every third patient treated with ECPR survived to hospital discharge, supporting previous data suggesting that ECPR may be beneficial in CA without ROSC. In conclusion, interventional cardiology is of paramount importance for ECPR programs.
Highlights
Current treatment algorithms for cardiac arrest (CA) advocate a prompt treatment of the underlying cause[1]
Patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) for of-hospital cardiac arrest (OHCA) were significantly younger than patients receiving ECPR for intra-hospital cardiac arrest (IHCA), with an overall mean age of 59 years (Table 1)
Whether early coronary angiography should be performed in all ECPR patients, or only after selection according to interpretation of electrocardiogram and other information as recommended in patients without CA or after return of spontaneous circulation (ROSC), has not been investigated systematically
Summary
Current treatment algorithms for cardiac arrest (CA) advocate a prompt treatment of the underlying cause[1]. A no-flow time of >8 min, an unwitnessed collapse, and an evident untreatable cause of CA are other factors that would not prompt ECPR initiation, but rather lead to termination of resuscitation efforts. Decision-making pro or contra initiation of ECPR is recommended after 15 min of advanced life support in our and many other centers to minimize low-flow time[9]. Together, these criteria are meant to ensure that a resource-intensive and highly invasive procedure such as ECPR is reserved to CA patients without ROSC, but still rather favorable prognosis. We set out to further investigate logistics and outcome of ECPR patients using an all-comers single-center registry
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