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Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study

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Abstract

Purpose

The aim of this study was to assess the neurologic outcome following extracorporeal cardiopulmonary resuscitation (ECPR) in five European centers.

Methods

Retrospective database analysis of prospective observational cohorts of patients undergoing ECPR (January 2012–December 2016) was performed. The primary outcome was 3-month favorable neurologic outcome (FO), defined as the cerebral performance categories of 1–2. Survival to ICU discharge and the number of patients undergoing organ donation were secondary outcomes. A subgroup of patients with stringent selection criteria (i.e., age ≤ 65 years, witnessed bystander CPR, no major co-morbidity and ECMO implemented within 1 h from arrest) was also analyzed.

Results

A total of 423 patients treated with ECPR were included (median age 57 [48–65] years; male gender 78%); ECPR was initiated for OHCA in 258 (61%) patients. Time from arrest to ECMO implementation was 65 [48–84] min. Eighty patients (19%) had favorable neurological outcome. ICU survival was 24% (n = 102); 23 (5%) non-survivors underwent organ donation procedures. Favorable neurological outcome rate was lower (9% vs. 34%, p < 0.01) in out-of-hospital than in-hospital cardiac arrest and was significantly associated with shorter time from collapse to ECMO. The application of stringent ECPR criteria (n = 105) resulted in 38% of patients with favorable neurologic outcome.

Conclusions

ECPR was associated with intact neurological recovery in 19% of unselected cardiac arrest victims, with 38% favorable outcome if stringent selection criteria would have been applied.

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Funding

No funding was received for this study.

Author information

Author notes

  1. Dirk Lunz and Lorenzo Calabrò contributed as first authors.

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany

    Dirk Lunz

  2. Department of Cardiothoracic Anesthesia and Intensive Care, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Lorenzo Calabrò, Anna Maria Scandroglio & Federico Pappalardo

  3. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Cliniques Universitaires de Bruxelles (CUB) Erasme, Route de Lennik, 808, 1070, Brussels, Belgium

    Lorenzo Calabrò, Daniel Patricio, Jacques Creteur & Fabio Silvio Taccone

  4. UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Mirko Belliato & Enrico Contri

  5. ECMO Centre Karolinska, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

    Lars Mikael Broman

  6. Department of Internal Medicine II, Cardiology and Pneumology, Intensive Care, University Medical Center Regensburg, Regensburg, Germany

    Maximilian Malfertheiner

  7. Department of Perfusion, University Hospital Regensburg, Regensburg, Germany

    Alois Philipp

Authors
  1. Dirk Lunz
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  2. Lorenzo Calabrò
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  10. Alois Philipp
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  11. Fabio Silvio Taccone
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  12. Federico Pappalardo
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Contributions

FST, MB, FP, LMB, and MW conceived the study protocol; FST, LMB, FP, MB, DL, and MW participated in the design and coordination of the study; LC, EC, AMS, DP, and AP collected study data; JC, MB, FP, LMB, and MW supervised data collection; FST, DL, LMB, FP, MW, JC, and DP participated in data interpretation; LC, EC, AMS, and AP were responsible for the literature search; FST, LMB, FP, MB, JC, DL, and MW drafted the present manuscript; LC, EC, AMS, DP, and AP revised the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Fabio Silvio Taccone.

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Conflicts of interest

MB, LMB, FST, and FP received honoraria from Eurosets (Medolla, Italy). The other authors have no conflict of interest to disclose.

Ethical approval

Ethical approval was obtained by the Ethics Committee of each participating center. Hôpital Erasme: P2017/263—Fondazione IRCCS Policlinico San Matteo: Prot 3RIA2 2016)—University Hospital Regensburg: 17-426-160—San Raffaele Hospital: Prot OUT IMP 17072013—Karolinska Institutet: 2016/2447-31/4.

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Lunz, D., Calabrò, L., Belliato, M. et al. Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study. Intensive Care Med 46, 973–982 (2020). https://doi.org/10.1007/s00134-020-05926-6

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  • DOI: https://doi.org/10.1007/s00134-020-05926-6

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