Korean J Thorac Cardiovasc Surg.  2016 Aug;49(4):273-279. 10.5090/kjtcs.2016.49.4.273.

Extracorporeal Cardiopulmonary Resuscitation: Predictors of Survival

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea. Jbkim1975@amc.seoul.kr

Abstract

BACKGROUND
The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR).
METHODS
Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated.
RESULTS
Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001).
CONCLUSION
These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients.

Keyword

Cardiac arrest; Cardiopulmonary resuscitation; Extracorporeal circulation; Sepsis

MeSH Terms

Adult
Cardiopulmonary Resuscitation*
Extracorporeal Circulation
Heart Arrest
Hospital Mortality
Humans
Hypovolemia
Methods
Mortality
Risk Factors
ROC Curve
Sensitivity and Specificity
Sepsis
Survival Rate
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