title: Predictors of survival following extracorporeal cardiopulmonary resuscitation in patients with acute myocardial infarction-complicated refractory cardiac arrest in the emergency department: a retrospective study.
abstract: BACKGROUND
  This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions.
  
  
  RESULTS
  Mean patient age was 61.4 ± 11.3 years, and 27 patients (73%) were men. Mean CPR time was 50.8 ± 35.4 min. Door-to-ECMO and door-to-balloon times were 84.4 ± 55.3 and 98.4 ± 56.8 min, respectively. Mean ECMO time was 106.4 ± 84.7 h; nine (24%) patients died within 24 h after ECMO initiation. Twelve (32%) patients were weaned off ECMO, seven (19%) of whom survived >30 days after ECMO removal; all except one had Cerebral Performance Category Grade 1. Of the patients who survived, 5 of them were able to be discharged. In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177-852.025; p = 0.033).
  
  
  CONCLUSIONS
  We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. medhan69@hallym.or.kr.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. cskhs99@hallym.or.kr.
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. jundure@hallym.or.kr.
authors.forename: Hyun Hee
authors.initials: HH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. kshong@hallym.or.kr.
authors.forename: Gyung Soon
authors.initials: GS
authors.lastname: Hong
authors.affiliation: Department of Urology, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. trupus@hallym.or.kr.
authors.forename: Won Ki
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 200-704, Republic of Korea. shlee1425@hallym.or.kr.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Anestheology, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Republic of Korea. imfm092@hallym.or.kr.
authors.forename: Dong Geun
authors.initials: DG
authors.lastname: You
authors.affiliation: Department of Anestheology, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, Republic of Korea. iloveu59@hallym.or.kr.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D004636:Emergency Service, Hospital; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies