title: [Resuscitation efficacy of extracorporeal membrane oxygenation in non-postcardiotomy adult patients with cardiac arrest].
abstract: Objective:To evaluate the resuscitation efficacy of extracorporeal membrane oxygenation (ECMO) for non-postcardiotomy cardiac arrest adult patients post failed conventional cardiopulmonary resuscitation (CCPR).Methods:We retrospectively analyzed the clinical data of a total of 25 consecutive adults who suffered from non-postcardiotomy cardiac arrest and were treated with ECMO post failed CCPR in our hospital between January 2010 and January 2015. Inclusion criteria included: 18 to 75 years old; the duration from cardiac arrest to CCPR initiation<5 minutes; no recovery of spontaneous circulation within 10 min after implementation of standard CCPR, and the length of CCPR <90 minutes. Patients were divided into non-survival group (18 cases) and survival group (7 cases) based on their in-hospital outcome and the clinical characteristics were compared. Related factors of survival to discharge were analyzed by Spearman correlation analysis.Results:Majority of patients (84.0%(21/25)) developed cardiac arrest in our hospital, mostly due to acute myocardial infarction (80.0%(20/25)). The mean duration of CCPR prior to ECMO support was 40.0 (27.5, 72.0) minutes. The mean duration of ECMO support was 72.0 (47.5, 128.3) hours and 9 patients (36.0%) were successfully weaned. Intensive care unit stay was significantly shorter (3.0(1.8-7.8)days vs.16.0(11.0-37.0) days,P<0.01), mean blood pressure at 24 and 48 hours after ECMO initiation was significantly lower ((73.2±20.1)mmHg(1 mmHg=0.133 kPa) vs. (91.1±20.4)mmHg,P<0.05; (63.0±16.7)mmHg vs. (86.6±18.0 mmHg),P<0.05, respectively) and platelet count at 72 hours after extracorporeal support was significantly lower ((57.0±30.1)×109/L vs. (97.3±31.5)×109/L,P<0.05) in the non-survivor group than in survival group. Spearman correlation analysis demonstrated that mean arterial pressure at 24 hours (r=0.427,P<0.05) and 48 hours(r=0.558,P<0.05), and platelet count at 72 hours after extracorporeal support (r=0.577,P<0.05) were significantly correlated with survival to discharge.Conclusion:ECMO can be used as an effective alternative for refractory cardiac arrest in non-postcardiotomy adult patients.
authors.affiliation: Heart Center, Tianjin Third Central Hospital, Tianjin 300170, China.
authors.forename: L
authors.initials: L
authors.lastname: Huang
authors.forename: Y W
authors.initials: YW
authors.lastname: Liu
authors.forename: T
authors.initials: T
authors.lastname: Li
authors.forename: X M
authors.initials: XM
authors.lastname: Hu
authors.forename: D W
authors.initials: DW
authors.lastname: Duan
authors.forename: P
authors.initials: P
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation; D006323:Heart Arrest; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult