title: Survival and quality of life after extracorporeal life support for refractory cardiac arrest: A case series.
abstract: OBJECTIVE
  Extracorporeal life support (ECLS) is an emerging option to treat selected patients with cardiac arrest refractory to cardiopulmonary resuscitation (CPR). Our primary objective was to determine the mortality at 30 days and at hospital discharge among adult patients receiving veno-arterial ECLS for refractory cardiac arrest. Our secondary objectives were to determine the 1-year survival and the health-related quality of life, and to examine factors associated with 30-day mortality.
  
  
  METHODS
  In a retrospective, single-center investigation within a tertiary referral center, we analyzed the prospectively collected data of 49 patients rescued from refractory cardiac arrest through emergent implantation of ECLS (E-CPR) (18.1% of our overall ECLS activity, 2005-2013), implanted in-hospital and during ongoing external cardiac massage in all cases. A prospective follow-up with administration of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire was performed.
  
  
  RESULTS
  The mean age was 47.6 ± 1.6 years; out-of-hospital cardiac arrest occurred in 12% of cases; average low-flow time was 47.2 ± 33 minutes; causes of cardiac arrest were heart disease (61.2%), trauma (14.3%), respiratory disease (4.1%), sepsis (2%), and miscellaneous (18.4%).
  
  
  OBJECTIVE
  Rates of survival at E-CPR explantation and at 30 days were 42.9% and 36.7%, respectively; brain death occurred in 24.5% of cases.
  
  
  OBJECTIVE
  Increased simplified acute physiology score; higher serum lactate levels and lower body temperature at the time of implantation were associated with 30-day mortality. Bridge to heart transplantation or implantation of a long-term ventricular assist device was performed in 8.2%. No deaths occurred during the follow-up after discharge (36.7% survival; average follow-up was 15.6 ± 19.2 months). The average Physical Component Summary and Mental Component Summary scores (SF-36 questionnaire) were, respectively, 45.2 ± 6.8 and 48.3 ± 7.7 among survivors.
  
  
  CONCLUSIONS
  Extracorporeal cardiopulmonary resuscitation is a viable treatment for selected patients with cardiac arrest refractory to CPR. In our series, approximately one third of rescued patients were alive at 6 months and presented quality-of-life scores comparable to those previously observed in patients treated with ECLS.
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France. Electronic address: amedeo.anselmi@alice.it.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Corbineau
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Langanay
authors.affiliation: Division of Cardiac Anesthesia, Pontchaillou University Hospital, Rennes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Bouquin
authors.affiliation: Division of Cardiology and Cardiac Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; INSERM (French National Institution for Healthcare and Medical Research), Unit 1099, University of Rennes 1, Rennes, France.
authors.forename: Vito Giovanni
authors.initials: VG
authors.lastname: Ruggieri
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support; D005112:Extracorporeal Circulation; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate
keywords: extracorporeal membrane oxygenation; health policy; outcomes; resuscitation