title: Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience.
abstract: BACKGROUND
  Cardiopulmonary resuscitation displays low survival rate after out-of-hospital cardiac arrest (OHCA). Extracorporeal life support (ECLS) could be suggested as a rescue therapeutic option in refractory OHCA. The aim of this report is to analyze our experience of ECLS implantation for refractory OHCA.
  
  
  METHODS
  We performed a retrospective observational analysis of our prospectively collected database. Patients were divided into a shockable rhythm (SH-R) and a non-shockable rhythm (NSH-R) group according to cardiac rhythm at ECLS implantation. The primary endpoint was survival to hospital discharge with good neurological recovery.
  
  
  RESULTS
  From January 2010 to December 2014 we used ECLS in 68 patients (SH-R, n=19, 27.9% vs. NSH-R, n=49, 72.1%) for refractory OHCA. The clinical profile before ECLS implantation was comparable between the groups. Eight (11.7%) patients were successfully weaned from ECLS (SH-R=31.5% vs. NSH-R=4.0%, p=0.01) after a mean period of support of 2.1 days (SH-R=4.1 days vs. NSH-R=1.4 days, p=0.01). Six (8.8%) patients survived to discharge (SH-R=31.5% vs. NSH-R=0%, p=0.00). In the SH-R group 50% of the survivors were discharged without neurological complications.
  
  
  CONCLUSIONS
  ECLS for refractory OHCA should be limited in consideration of its poor, especially neurological, outcome. Non-shockable rhythms could be considered as a formal contraindication allowing a concentration of our efforts on the shockable rhythms, where the chances of success are substantial.
authors.affiliation: Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France. Electronic address: mpozzi1979@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pozzi
authors.affiliation: Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Koffel
authors.affiliation: Division of Clinical Research and Innovation, Innovation Department/UMR CNRS 5510 MATEIS, Equipe I2B, Lyon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Armoiry
authors.affiliation: Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pavlakovic
authors.affiliation: Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Neidecker
authors.affiliation: Department of Cardiology, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Prieur
authors.affiliation: Department of Cardiology, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy
authors.affiliation: Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Robin
authors.affiliation: Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Obadia
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality* / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008021:Life Support Systems / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Assisted circulation; Cardiopulmonary resuscitation; Extracorporeal life support; Out-of-hospital cardiac arrest; Ventricular fibrillation