title: Usefulness of routine laboratory parameters in the decision to treat refractory cardiac arrest with extracorporeal life support.
abstract: OBJECTIVE
  To evaluate the usefulness of routine laboratory parameters in the decision to treat refractory cardiac arrest patients with extracorporeal life support (ECLS).
  
  
  METHODS
  Sixty-six adults with witnessed cardiac arrest of cardiac origin unrelated to poisoning or hypothermia undergoing cardiopulmonary resuscitation without return of spontaneous circulation (duration: 155 min [120-180], median, [25-75%-percentiles]) were included in a prospective cohort-study. ECLS was implemented under cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane-oxygenator, aiming to maintain ECLS flow ≥ 2.5 l/min and mean arterial pressure ≥ 60 mm Hg.
  
  
  RESULTS
  Forty-seven of 66 patients died within 24 h from multiorgan failure and massive capillary leak. Of 19/66 patients who survived ≥ 24 h with stable circulatory conditions permitting neurological evaluation, four became conscious and were transferred for further cardiac assistance, while three became organ donors. Ultimately, one patient survived without neurologic sequelae after cardiac transplantation. Using multivariate analysis, only pre-cannulation peripheral venous oxygen saturation (SpvO₂, 28% [15-52]) independently predicted inability to maintain targeted ECLS conditions ≥ 24 h (odds ratio for each 10%-decrease [95%-confidence interval]: 1.65 [1.21; 2.25], p=0.002). The area under the receiver-operating-characteristics curve was 0.78 [0.63; 0.93]. SpvO₂ cut-off value of 33% was associated with a sensitivity of 0.68 [0.50; 0.83] and specificity of 0.81 [0.54; 0.96]. SpvO₂ ≤ 8%, lactate concentration ≥ 21 mmol/l, fibrinogen ≤ 0.8 g/l, and prothrombin index ≤ 11% predicted premature ECLS discontinuation with a specificity of 1.
  
  
  CONCLUSIONS
  SpvO₂ is useful to predict the inability of maintaining refractory cardiac arrest victims on ECLS without detrimental capillary leak and multiorgan failure until neurological evaluation.
authors.affiliation: Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Medical and Toxicological Critical Care Department, Paris-Diderot University, 75010 Paris, France. bruno-megarbane@wanadoo.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Isabelle
authors.initials: I
authors.lastname: Malissin
authors.forename: Dabor
authors.initials: D
authors.lastname: Résière
authors.forename: Hakim
authors.initials: H
authors.lastname: Haouache
authors.forename: Pierre
authors.initials: P
authors.lastname: Brun
authors.forename: William
authors.initials: W
authors.lastname: Haik
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods / Q000401:mortality; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality*; D005260:Female; D005602:France; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D019233:Retreatment / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D017211:Treatment Failure