SESSION TITLE: Hot Topics in Pulmonary & Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM
PURPOSE: Despite advances in medical care, survival to discharge and full neurological recovery after cardiac arrest (CA) remains < 20%. An alternate approach to traditional CPR is E-CPR, which provides immediate cardiovascular support when traditional methods fail. Renewed interest in ECMO has resulted in the use of ECMO during CPR (E-CPR) to improve outcomes.
METHODS: Between 2010 and 2013, a total of 100 ECMO procedures were performed at our institution. 24 cases unresponsive to conventional CPR had E-CPR. Patient demographics, survival to discharge, and neurological recovery were retrospectively analyzed with IRB approval.
RESULTS: Of the 24 patients who received E-CPR, there were 15 males and 9 females, with a mean age of 47 ± 16 years. The etiologies (#) for E-CPR in these patients were: acute myocardial infarction (9), malignant arrhythmia (4), myocarditis (3), acute pulmonary emboli (2), hypothermia (2), and 1 case each of acute rejection, drug overdose induced cardiac arrest, post-cardiotomy failure, and septic shock. The mean duration of ECMO support was 5.0 ± 6.6 days. All patients who met criteria were placed on 24 hr. hypothermia protocol with initiation of ECMO. 13 of 24 (54%) patients survived E-CPR. 7/13 patients were discharged without any neurological sequence. 6/13 patients died post-ECMO but pre-discharge from anoxic brain injury (4), sepsis (1), and stroke (1). The causes of death on E-CPR were: anoxic brain injury (5), stroke (3), metabolic acidosis (1), bowel necrosis (1), and family’s withdrawal (1). 2/5 patients with anoxic brain injury on E-CPR donated multiple organs for transplant. The hospital discharge to survival rate was 53% (7/13 patients) with full neurological recovery.
CONCLUSIONS: The E-CPR provided improved survival and neurological recovery compared to national in-hospital post-CPR statistics. E-CPR also made multi-organ procurement possible. The protection of patients’ brains remains an issue to be addressed in order for survival rates to be further improved.
CLINICAL IMPLICATIONS: Based on the above survival rates, E-CPR should be considered when determining the optimal treatment path for patients who need cardiopulmonary resuscitation. The proper use of E-CPR improved hospital outcomes for the arrested patients.
DISCLOSURE: The following authors have nothing to disclose: Graham Peigh, Harrison Pitcher, Nicholas Cavarocchi, Hitoshi Hirose
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