Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: A propensity-matched analysis.
OBJECTIVE
Extracorporeal life support (ECLS) has shown encouraging survival rates in patients with in-hospital cardiac arrest; however, its routine use is still controversial. We compared the survival of patients with in-hospital cardiac arrest receiving conventional cardiopulmonary resuscitation (CCPR) to that of patients with ECLS as an adjunct to cardiopulmonary resuscitation (ECPR).


METHODS
A total of 353 patients with in-hospital cardiac arrest (272 CCPR and 52 ECPR) were included in this retrospective, propensity score-adjusted (1:1 matched), single-centre study. Primary endpoints were survival at 30 days, long-term survival and neurological outcome defined by the cerebral performance categories score.


RESULTS
In the unmatched groups patients undergoing ECPR initially had significantly higher APACHE II scores ( P=0.03), increased norepinephrine dosages ( P=0.03) and elevated levels of creatine kinase ( P<0.0001), creatinine ( P=0.04) and lactate ( P=0.02) before cardiopulmonary resuscitation compared with those undergoing CCPR. After equalising these parameters significant differences were observed in short and long-term survival, favouring ECPR over CCPR (27% vs. 17%; P=0.01 (short-term) and 23.1% vs. 11.5%; P=0.008 (long-term); median follow-up duration after discharge 1136 days (interquartile range 823-1416)). There was no significant difference in the incidence of a cerebral performance categories score of 1 or 2 between the matched groups (CCPR 66.7% vs. ECPR 83.3%; P=0.77). ECLS implantation was the only significant and independent predictor of mortality in multivariate Cox regression analysis (hazard ratio 0.57, 95% confidence interval 0.35-0.90; P=0.02).


CONCLUSIONS
In our cohort of cardiovascular patients ECPR was associated with better short- and long-term survival over CCPR, with a good neurological outcome in the majority of the patients with refractory in-hospital cardiac arrest.
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Johannes
J
Blumenstein
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Jürgen
J
Leick
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Christoph
C
Liebetrau
2 Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Germany.
Joerg
J
Kempfert
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Luise
L
Gaede
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Sebastian
S
Groß
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Marcel
M
Krug
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Alexander
A
Berkowitsch
3 Justus Liebig University of Giessen, Department of Internal Medicine I, Germany.
Holger
H
Nef
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.|3 Justus Liebig University of Giessen, Department of Internal Medicine I, Germany.
Andreas
A
Rolf
4 Department of Anesthesiology, Kerckhoff Heart and Thorax Center, Germany.
Matthias
M
Arlt
2 Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Germany.
Thomas
T
Walther
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.|3 Justus Liebig University of Giessen, Department of Internal Medicine I, Germany.
Christian W
CW
Hamm
1 Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany.
Helge
H
Möllmann
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
Cardiopulmonary resuscitation; extracorporeal life support; in-hospital cardiac arrest; neurological outcome