title: Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience.
abstract: OBJECTIVE
  To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications.
  
  
  METHODS
  Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres in Sydney, Australia.
  
  
  RESULTS
  Thirty-seven patients underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age was 54 (IQR 47-58), 27 (73%) were male. Initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 20 patients (54%), pulseless electrical activity (n=14, 38%), and asystole (n=3, 8%). 27 (73%) arrests were witnessed and 30 (81%) patients received bystander CPR. Median time from arrest to initiation of ECMO flow was 45min (IQR 30-70), and the median time on ECMO was 3days (IQR 1-6). Angiography was performed in 54% of patients, and 27% required subsequent coronary intervention (stenting or balloon angioplasty 24%). A total of 13 patients (35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All survivors were discharged with favourable neurological outcome (Cerebral Performance Category 1 or 2). Pre-ECMO lactate level was predictive of mortality OR 1.35 (1.06-1.73, p=0.016).
  
  
  CONCLUSIONS
  In selected patients with refractory cardiac arrest, ECPR may provide temporary support as a bridge to intervention or recovery. We report favourable survival and neurological outcomes in one third of patients and pre-ECMO lactate levels predictive of mortality. Further studies are required to determine optimum selection criteria for ECPR.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: mden5273@uni.sydney.edu.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Department of Intensive Care, St Vincent's Hospital, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McCanny
authors.affiliation: Sydney Local Health District, Clinical Research Centre, Australia.
authors.forename: Mario
authors.initials: M
authors.lastname: D'Souza
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiothoracic Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Forrest
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance Service, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
authors.affiliation: Department of Intensive Care, St Vincent's Hospital, Sydney, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Lowe
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Gattas
authors.affiliation: Department of Emergency Medicine, St Vincent's Hospital, Sydney, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Scott
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Bannon
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Granger
authors.affiliation: Department of Intensive Care, St Vincent's Hospital, Sydney, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Pye
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Totaro
mesh_terms: D001315:Australia / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: CPR; Cardiac arrest; Cardiopulmonary resuscitation; ECLS; ECMO; ECPR; ELS; Extracorporeal membrane oxygenation