The Use of ECMO for the Treatment of Refractory Cardiac Arrest or Postarrest Cardiogenic Shock Following In-Hospital Cardiac Arrest: A 10-Year Experience

• Published in: Journal of Intensive Care Medicine Vol. 34; no. 8; pp. 615 - 621
• Main Authors: Chonde, Meshe, Sappington, Penny, Kormos, Robert, Althouse, Andrew, Boujoukos, Arthur
• Format: Book Review Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-08-2019
• Subjects: Adult; Aged; Extracorporeal Membrane Oxygenation; Female; Follow-Up Studies; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Male; Middle Aged; Registries; Retrospective Studies; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Survival Analysis; Treatment Outcome; ECMO; ECPR; postarrest cardiogenic shock; cardiac arrest
• ISSN: 0885-0666; 1525-1489
• DOI: 10.1177/0885066617751398

Objectives:
Extracorporeal membrane oxygenation (ECMO) has been increasingly used in the treatment of refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation [ECPR]) and postarrest cardiogenic shock (PACS). Our primary objective was to determine the 1-year survival of patients who were treated with ECMO for PACS or in ECPR.
Methods:
We conducted a retrospective analysis of hospitalized patients in a tertiary care facility who underwent treatment with ECMO for ECPR or PACS. Between January 2004 and December 2013, patients were prospectively entered into an institutional registry. One-year follow-up was assessed by electronic medical record or social security death index if clinical follow-up was unavailable.
Results:
Fifty-one patients were treated with ECMO during the study period. The mean age was 54.0 ± 10.9 years; the majority of patients were men (80.4%). The most common etiology of arrest was acute myocardial infarction (51.0%). Overall, 13 (25.4%) patients survived for at least 1 year. Preexisting coronary artery disease, hypertension, and hyperlipidemia were associated with reduced likelihood of survival. We observed a significant improvement in 1-year mortality in patients treated for PACS when compared to ECPR, 46.7% versus 16.7%, respectively.
Conclusion:
The use of ECMO for treatment of refractory cardiac arrest or cardiogenic shock may be a suitable treatment in a very select cohort of patients. Our results support a significantly higher 1-year survival in patients with PACS compared to refractory cardiac arrest.