title: Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Cardiac arrest is the major cause of sudden death in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) employs extracorporeal membrane oxygenation (ECMO) in patients without return of spontaneous circulation (ROSC) by conventional cardiopulmonary resuscitation (CPR). Aim of the current study was to assess short- and long-term outcome in patients treated with ECPR in our tertiary center and to identify predictors of outcome.
  
  
  METHODS
  We retrospectively collected data of all patients treated with ECPR at our institution from 2002 to 2013. Outcome was assessed according to patient records; good neurological outcome was defined as cerebral performance category 1 or 2. Quality of life data was collected using EQ-5 questionnaire. Uni- and multivariate analysis was applied to identify predictors of outcome.
  
  
  RESULTS
  One-hundred and seventeen patients were included into the study. Weaning from ECMO was successful in 61 (52 %) patients. Thirty-day survival endpoint was achieved by 27 (23 %) patients. Good neurological outcome was present in 17 (15 %) patients. Multivariate analysis revealed baseline serum lactate as the strongest predictor of outcome, whereas age and out-of-hospital CPR did not predict outcome. The optimal lactate cut-off to discriminate outcome was determined at 4.6 mmol/l [HR 3.55 (2.29-5.49), p < 0.001, log-rank test].
  
  
  CONCLUSIONS
  ECPR represents a treatment option in patients without ROSC after conventional CPR rescuing 15 % of patients with good neurological outcome. Serum lactate may play a crucial role in patient selection for ECPR.
authors: Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany. christian.jung@med.uni-jena.de.
authors: Christian
authors: C
authors: Jung
authors: Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany. kyra_janssen@web.de.
authors: Kyra
authors: K
authors: Janssen
authors: Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany. mirko.kaluza@med.uni-jena.de.
authors: Mirko
authors: M
authors: Kaluza
authors: Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany. georg.fuernau@uksh.de.
authors: Georg
authors: G
authors: Fuernau
authors: Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany. tudor.poerner@med.uni-jena.de.
authors: Tudor Constantin
authors: TC
authors: Poerner
authors: Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany. michael.fritzenwanger@med.uni-jena.de.
authors: Michael
authors: M
authors: Fritzenwanger
authors: Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany. ruediger.pfeifer@med.uni-jena.de.
authors: Ruediger
authors: R
authors: Pfeifer
authors: Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany. holger.thiele@uksh.de.
authors: Holger
authors: H
authors: Thiele
authors: Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany. hans.figulla@med.uni-jena.de.
authors: Hans Reiner
authors: HR
authors: Figulla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: CPR; ECMO; Outcome; Resuscitation