Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)

Tobias Wengenmayer, Stephan Rombach, Florian Ramshorn, Paul Biever, Christoph Bode, Daniel Duerschmied, Dawid L Staudacher, Tobias Wengenmayer, Stephan Rombach, Florian Ramshorn, Paul Biever, Christoph Bode, Daniel Duerschmied, Dawid L Staudacher

Abstract

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support under extracorporeal cardiopulmonary resuscitation (eCPR) is the last option and may be offered to selected patients. Several factors predict outcome in these patients, including initial heart rhythm, comorbidities, and bystander cardiopulmonary resuscitation (CPR). We evaluated outcomes of all VA-ECMO patients treated within the last 5 years at our center in respect to low-flow duration during CPR.

Methods: We report retrospective registry data on all patients with eCPR treated at a university hospital between October 2010 and May 2016.

Results: A total of 133 patients (mean age 58.7 ± 2.6 years, Simplified Acute Physiology Score II score at admission 48.1 ± 3.4) were included in the analysis. The indication for eCPR was either in-hospital or out-of-hospital cardiac arrest without return of spontaneous circulation (n = 74 and 59, respectively). There was a significant difference in survival rates between groups (eCPR in-hospital cardiac arrest [IHCA] 18.9%, eCPR out-of-hospital cardiac arrest [OHCA] 8.5%; p < 0.042). Mean low-flow duration (i.e., duration of mechanical CPR until VA-ECMO support) was 59.6 ± 5.0 minutes in all patients and significantly shorter in IHCA patients than in OHCA patients (49.6 ± 5.9 vs. 72.2 ± 7.4 minutes, p = 0.001). Low-flow time strongly correlated with survival (p < 0.001) and was an independent predictor of mortality.

Conclusions: Time to full support is an important and alterable predictor of patient survival in eCPR, suggesting that VA-ECMO therapy should be established as fast as possible in the selected patients destined for eCPR.

Keywords: Cardiac arrest; Chest compression; ECLS; Low flow; Outcome; Venoarterial extracorporeal membrane oxygenation.

Figures

Fig. 1
Fig. 1
Mean survival of all extracorporeal cardiopulmonary resuscitation patients. OHCA Out-of-hospital cardiac arrest, IHCA In-hospital cardiac arrest
Fig. 2
Fig. 2
Scatterplot of low-flow time in survivors and nonsurvivors (*** p = 0.003). Low-flow time means duration of mechanical cardiopulmonary resuscitation before full extracorporeal membrane oxygenation support
Fig. 3
Fig. 3
Scatterplot of low-flow time in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients (*** p = 0.001). Low-flow time means duration of mechanical cardiopulmonary resuscitation before full extracorporeal membrane oxygenation support
Fig. 4
Fig. 4
Mean survival for extracorporeal cardiopulmonary resuscitation patients after 6–20, 20–45, 45–60, and 60–135 minutes of mechanical cardiopulmonary resuscitation (CPR) (*** p = 0.001)
Fig. 5
Fig. 5
Estimated survival rates for extracorporeal membrane oxygenation (eCPR) patients after every given low-flow time (red line). For comparison, data from Goto et al. [16] representing survival after mechanical cardiopulmonary resuscitation (CPR) are included (dashed blue line)

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