Abstract 13691: Extracorporeal Cardiopulmonary Resuscitation for Nonshockable Rhythms

Introduction: In cardiac arrest patients, patients with shockable rhythms have more favorable outcomes than those with non-shockable rhythms. Recently, alternative cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) has shown the potential to improve the outcomes of patients who are unresponsive to conventional CPR. Hypothesis: We assessed the hypothesis that initial shockable rhythms are associated with improved outcomes in extracorporeal CPR (ECPR) using ECMO. Methods: Patients who were treated with ECPR were enrolled in this study. Patients were divided into 2 groups according to the whether the initial recorded rhythms were shockable (shockable group) or not (nonshockable group). Baseline characteristics and 90-day survival were assessed. We constructed 90-day survival curves using the Kaplan-Meier method. A P < 0.05 was defined as statistically significant. Results: The study patients in the shockable and nonshockable groups were similar in terms of age, witnessed to arrest, bystander initiated CPR, collapse to CPR, collapse to initiation of ECMO. Patients in the shockable group were more likely than those in the nonshockable group to undergo immediate coronary angiography (91% vs. 66%, P < 0.001), subsequent coronary revascularization (55% vs. 37%, P = 0.02), and targeted temperature management (56% vs. 49%, P = 0.37). The rates of return of spontaneous heart-beat (88% vs. 91%, P = 0.58) and weaning from ECMO (48% vs. 40%, P = 0.25) were similar between groups. The 90-day survival curves are shown in the figure. Cox proportional hazard regression suggested that the initial shockable rhythm was not an independent predictors of 90-day survival. Conclusions: Unlike in conventional CPR, the initial nonshockable rhythm is not necessarily associated with an adverse outcome. However, none of the patients with an initial asystole rhythm survived up to 90 days.