Cardiac Arrest in the Era of Mechanical Circulatory Support: A Single Center Experience with Extracorporeal Cardiopulmonary Resuscitation

Extracorporeal cardiopulmonary resuscitation (ECPR) has recently been gaining popularity. We document our experience with ECPR following in-hospital cardiac arrest. This is a retrospective review of 47 adult patients who received ECPR from March 2007 to July 2013 at our institution. The primary outcome of interest was survival to discharge. Mean age was 57.5 ± 16.4 years and 59.8% of the patients were male. Duration of CPR was 29.6 ± 15.9 minutes. CPR was performed for less than 20 min in 11 patients, between 20-40 min in 12 patients, and for more than 40 min in 10. Overall 29.8% survived to discharge. Only age was found to be significantly different between those who survived to discharge and those who did not (50.4 ± 15.1 years in survivors, 60.5 ± 15.0 years in non-survivors, p=0.05). Myocardial recovery was achieved in 17% of patients (8) and 31.9% (15) were transitioned to another ventricular assist device. Causes of death included multi-system organ failure in 13 patients (27.7%), neurologic non-recovery in 10 patients (21.3%), and cardiac failure in 9 (19.1%). Bivariate analysis revealed age (OR: 1.05, CI: 1.00 - 1.09, p=0.04) and etiology of AMI (OR: 0.24, CI: 0.06 - 0.95, p=0.04) to be significant predictors and protective factors, respectively, for in hospital mortality. Duration of CPR was not a significant predictor of worse outcomes (OR: 0.96, CI: 0.92 - 1.02, p=0.21). Survival to discharge was 27.7% with CPR<20 min, 16.7%% with CPR 20-40min, and 50% with CPR>40min. Approximately 30% of patients undergoing ECPR survived to discharge. Those with younger age and cardiac arrest in the setting of AMI have better outcomes. Extended duration of CPR was not a predictor of in hospital mortality. Further investigation will help identify the patient population that will maximally benefit from ECPR.