title: Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  This study aimed to identify predictors of mortality in patients with out-of-hospital cardiac arrest (OHCA) undergoing in-hospital extracorporeal life support system (ECLS) treatment.
  
  
  METHODS
  We retrospectively studied the characteristics and clinical outcomes of 28 patients (January 2010 and December 2011) with OHCA and veno-arterial ECLS implemented during ongoing cardiopulmonary resuscitation (CPR) upon admission to the cath lab. Baseline left ventricular ejection fraction (LVEF) was determined after ECLS implantation and then every 24 h during and after successful weaning from ECLS.
  
  
  RESULTS
  Overall 30-day survival rate was 39.3 % (11 of 28 patients). Baseline characteristics, initial laboratory measurements, and LVEF on admission were not significantly different between survivors and non-survivors. There was no difference regarding median CPR duration [survivors 44.0 min (IQR 31.0-45.0) vs. non-survivors 53.0 min (IQR 40.0-61.3); P = 0.23]. Door-to-ECLS implantation time was significantly longer in non-survivors [42.5 min (IQR 28.0-56.5) vs. 25.0 min (IQR 21.0-30.0); P < 0.01]. ECLS treatment duration was not significantly different between the two groups [survivors: 4.0 days (IQR 1.5-7.5) vs. non-survivors 6.5 days (IQR 1.0-8.0); P = 0.69]. LVEF significantly improved in survivors during ECLS treatment (mean ± SD survivor 47.5 ± 14.7 % vs. non-survivor 23.3 ± 14.9 %; P < 0.01). The door-to-ECLS implantation time was the only significant and independent predictor of 30-day mortality in multivariate Cox regression analysis (P = 0.04). Kaplan-Meier survival analysis showed a benefit favouring patients with a door-to-ECLS implantation time <30 min (log rank 6.29; P = 0.01).
  
  
  CONCLUSIONS
  A door-to-ECLS implantation time <30 min significantly improves 30-day outcomes in patients with OHCA.
authors: Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
authors: Jürgen
authors: J
authors: Leick
authors: Christoph
authors: C
authors: Liebetrau
authors: Sebastian
authors: S
authors: Szardien
authors: Ulrich
authors: U
authors: Fischer-Rasokat
authors: Matthias
authors: M
authors: Willmer
authors: Arnaud
authors: A
authors: van Linden
authors: Johannes
authors: J
authors: Blumenstein
authors: Holger
authors: H
authors: Nef
authors: Andreas
authors: A
authors: Rolf
authors: Matthias
authors: M
authors: Arlt
authors: Thomas
authors: T
authors: Walther
authors: Christian
authors: C
authors: Hamm
authors: Helge
authors: H
authors: Möllmann
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D010343:Patient Admission; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D016277:Ventricular Function, Left
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