title: Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients.
abstract: The role of extracorporeal cardiopulmonary resuscitation (ECPR) in adult cardiac surgery patients with refractory cardiac arrest is uncertain. We hypothesized that ECPR would be associated with better than expected outcomes in this group of patients.
  
  
  
  We conducted a single-center retrospective cohort study of adult cardiac surgery patients who underwent ECPR for refractory cardiac arrest during a 6-year period (2010 to 2015). In-hospital mortality, survival at last follow-up, and cerebral performance category (CPC) were examined as outcomes, and potential risk factors for mortality were explored.
  
  
  
  Twenty-three patients underwent ECPR when spontaneous circulation did not return with conventional resuscitation. Thirty-day mortality was 65.2%, and in-hospital mortality was 69.6%. Six of the 23 patients (26.1%) were discharged with a favorable neurologic outcome, defined as CPC 1 or 2. Most patients who died had multiple organ dysfunction syndrome (43.8%), and a smaller number had severe brain injury (25.0%). Kaplan-Meier survival analysis suggested age as a critical factor affecting survival (P = .04, log-rank test).
  
  
  
  ECPR may have a role in younger adult cardiac surgery patients who experience refractory cardiac arrest. Future studies are needed to identify patients who will benefit most from ECPR.
authors.affiliation: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Md; Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, Md. Electronic address: mmazzeffi@anes.umm.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mazzeffi
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.affiliation: Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herr
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Eric
authors.initials: E
authors.lastname: Krause
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Evans
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Raymond
authors.initials: R
authors.lastname: Rector
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Brian
authors.initials: B
authors.lastname: McCormick
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Si
authors.initials: S
authors.lastname: Pham
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Bradley
authors.initials: B
authors.lastname: Taylor
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
authors.affiliation: Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: ECMO; cardiac arrest; cardiac surgery; resuscitation