Feasibility of Extracorporeal Life Support for Out-of-Hospital Cardiac Arrest Patients who are Unresponsive to Conventional Cardiopulmonary Resuscitation

Moon, Sung Woo; Lee, Sung Woo; Shin, Jae Seung; Jung, Jae Ho; Jung, Won Jae; Kim, Kwang Ja; Hong, Yun Sik; Horn, Jan Kurt

Abstract

PURPOSE: To determine the feasibility of using extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) patients who are unresponsive to conventional cardiopulmonary resuscitation (CPR) techniques.
METHODS
This study was a case series of consecutive nontraumatic OHCA patients aged 18~75 years who received ECLS in the emergency department (ED) of a university teaching hospital. We analyzed outcomes, physiologic effects, and complications associated with ECLS. To compare outcomes of ECLS and conventional CPR, we selected a conventional CPR subgroup, those who were aged 18 to 75 years, who experienced cardiac arrest with pre-hospital CPR, who had no terminal illness, and who had CPR for more than 40 minutes.
RESULTS
Of 14 attempts to initiate ECLS, 13 patients received ECLS and one patient failed catheterization. Nine patients achieved return of spontaneous circulation (ROSC) more than 20 minutes later; 4 of the 9? patients survived more than 24 hours; 2 patients were successfully weaned off ECLS; 1 patient was discharged alive without neurologic complications. Median (minimum-maximum) duration of CPR before ECLS (pre-hospital and in-hospital) was 84(41 to 167) minutes. Blood gas parameters obtained 3 hours after the start of ECLS were significantly improved compared with those obtained pre-ECLS. Four patients who arrested from acute myocardial infarction received intervention as during ECLS support to correct the causes of the arrest. Serious complications of ECLS causing mortality were catheterization failure, intracranial hemorrhage, and massive hemothorax. The ECLS group showed a higher ROSC rate than patients who received conventional CPR without ECLS (64.3% vs. 7.1%, p=0.002).
CONCLUSION
ECLS in the ED is feasible for OHCA patients who are unresponsive to prolonged CPR. ECLS provides a bridge to evaluation and definitive care in refractory OHCA by improving early hemodynamic and physiologic status. Earlier application of ECLS and reduction of complications associated with ECLS may improve the survival of OHCA patients.