title: Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) support has been suggested to improve the survival rate in patients with refractory in- and out-of-hospital cardiac arrest (IHCA and OHCA). The aim of our study is to report our experience with ECMO in these patients.
  
  
  METHODS
  Retrospective, single-centre, observational study.
  
  
  METHODS
  From January 2006 to February 2011 we studied 42 patients (31 males) with refractory cardiac arrest.
  
  
  RESULTS
  ECMO implantation was successful in 38 (90%) of the 42 patients. ECMO support was positioned: three times (8%) in the operating room, six (16%) in the cardiac surgery intensive care unit, 21 (55%) in the emergency room, five (13%) in the catheterisation laboratory and three (8%) in the general ward. A total of 14 IHCA (58%) and three OHCA (16%) patients were weaned from ECMO (p<0.05). Eleven IHCA (46%) and one OHCA (5%, p<0.05) patients were discharged from intensive care unit (ICU). Among IHCA patients, 10 were alive at 6 months, nine of whom (38%) with good neurological outcome. Among OHCA patients weaned from ECMO, one was alive at 6 months with good neurological outcome (5%, p<0.05 vs. IHCA).
  
  
  CONCLUSIONS
  ECMO support should be considered as a resuscitation alternative in selected patients. More specifically, patients with witnessed IHCA benefit more from ECMO treatment compared to those who experience an out-of-hospital cardiac arrest.
authors: Servizio di Anestesia e Rianimazione 1, U.O.S. Anestesia e Terapia intensiva CCH, Università Milano-Bicocca, Ospedale S.Gerardo, via Pergolesi 33, 20052 Monza, Italy. l.avalli@hsgerardo.org
authors: Leonello
authors: L
authors: Avalli
authors: Elena
authors: E
authors: Maggioni
authors: Francesco
authors: F
authors: Formica
authors: Gianluigi
authors: G
authors: Redaelli
authors: Maurizio
authors: M
authors: Migliari
authors: Monica
authors: M
authors: Scanziani
authors: Simona
authors: S
authors: Celotti
authors: Anna
authors: A
authors: Coppo
authors: Rosa
authors: R
authors: Caruso
authors: Giuseppe
authors: G
authors: Ristagno
authors: Roberto
authors: R
authors: Fumagalli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult