Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation.
OBJECTIVE
Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution.


METHODS
This is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared.


RESULTS
The overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0. 0998) at 1 year after discharge.


CONCLUSIONS
The management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR.
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Fu-Yuan
FY
Siao
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Chun-Chieh
CC
Chiu
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Chun-Wen
CW
Chiu
Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Ying-Chen
YC
Chen
Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Yao-Li
YL
Chen
Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Yung-Kun
YK
Hsieh
Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Chien-Hui
CH
Lee
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Chang-Te
CT
Wu
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Chu-Chung
CC
Chou
Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; College of Medicine, Chung-Shan Medical University, Taichung, Taiwan. Electronic address: 91646@cch.org.tw.
Hsu-Heng
HH
Yen
D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004636:Emergency Service, Hospital; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications* / Q000401:mortality; D055815:Young Adult
Cardiac arrest; Cardiopulmonary resuscitation; Conventional cardiopulmonary resuscitation (C-CPR); Extracorporeal cardiopulmonary resuscitation (E-CPR); Extracorporeal membrane oxygenation (ECMO); Refractory ventricular fibrillation