Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients
Journal of Thoracic and Cardiovascular Surgery
cardiac arrest; cardiac surgery; ECMO; resuscitation
Background The role of extracorporeal cardiopulmonary resuscitation (ECPR) in adult cardiac surgery patients with refractory cardiac arrest is uncertain. We hypothesized that ECPR would be associated with better than expected outcomes in this group of patients. Methods We conducted a single-center retrospective cohort study of adult cardiac surgery patients who underwent ECPR for refractory cardiac arrest during a 6-year period (2010 to 2015). In-hospital mortality, survival at last follow-up, and cerebral performance category (CPC) were examined as outcomes, and potential risk factors for mortality were explored. Results Twenty-three patients underwent ECPR when spontaneous circulation did not return with conventional resuscitation. Thirty-day mortality was 65.2%, and in-hospital mortality was 69.6%. Six of the 23 patients (26.1%) were discharged with a favorable neurologic outcome, defined as CPC 1 or 2. Most patients who died had multiple organ dysfunction syndrome (43.8%), and a smaller number had severe brain injury (25.0%). Kaplan-Meier survival analysis suggested age as a critical factor affecting survival (P = .04, log-rank test). Conclusions ECPR may have a role in younger adult cardiac surgery patients who experience refractory cardiac arrest. Future studies are needed to identify patients who will benefit most from ECPR.
Mazzeffi, M., Sanchez, P., Herr, D., Krause, E., Evans, C., Rector, R., McCormick, B., Pham, S., Taylor, B., Griffith, B., & Kon, Z. (2016). Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients. Journal of Thoracic and Cardiovascular Surgery, 152 (4). http://dx.doi.org/10.1016/j.jtcvs.2016.06.014