title: Out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal membrane oxygenation: focus on survival rate and neurologic outcome.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is a useful treatment for refractory out-of-hospital cardiac arrest (OHCA). However, little is known about the predictors of survival and neurologic outcome after ECMO. We analyzed our institution's experience with ECMO for refractory OHCA and evaluated the predictors of survival and neurologic outcome after ECMO.
  
  
  METHODS
  This was a retrospective review of the medical records of 23 patients who were treated with ECMO due to OHCA that was unresponsive to conventional cardiopulmonary resuscitation, between January 2009 and January 2014.
  
  
  RESULTS
  Our ECMO team was activated within 10 min for refractory OHCA, and the 30-day survival rate was 43.5 %. In a multivariate analysis that evaluated independent factors contributing to mortality, urine output  ≤ 0.5 mL · kg(-1) · h(-1) (defined as oliguria) during the 24 h after ECMO was statistically significant (OR, 32.271; 95 % CI, 1.379-755.282; p = 0.031). Just after ECMO implantation, 6 of the 9 patients (66.7 %) who had normal findings on brain computed tomography (CT) survived with a cerebral performance category (CPC) of grade 1. However, only 3 of the 11 patients (27 %) who had evidence of hypoxic brain damage on initial brain CT survived (their CPC grade was 4).
  
  
  CONCLUSIONS
  Based on our findings, the survival rate can be improved by rapid implantation of ECMO, and oliguria seen during the first 24 h after ECMO may be an independent predictor of mortality. Furthermore, findings on brain CT just after ECMO and subsequent images may represent an important predictor for neurologic outcome after ECMO.
authors.affiliation: Department of Anesthesiology, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea. cskhs99@hallym.or.kr.
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Kyung Soon
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Hyun Hee
authors.initials: HH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Jeong Yeol
authors.initials: JY
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Heung Cheol
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Seonju
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Sung Mi
authors.initials: SM
authors.lastname: Hwang
authors.affiliation: Department of Emergency Medicine, Hallym University Medical Center, Chuncheon, South Korea.
authors.forename: Sang Ook
authors.initials: SO
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Extracorporeal membrane oxygenation; Neurologic outcome; Oliguria; Out-of-hospital cardiac arrest; Survival rate