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...

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Bibliographic Details
Published in:International journal of cardiology 2016-02, Vol.204, p.70-76
Main Authors: Pozzi, Matteo, Koffel, Catherine, Armoiry, Xavier, Pavlakovic, Isabelle, Neidecker, Jean, Prieur, Cyril, Bonnefoy, Eric, Robin, Jacques, Obadia, Jean-François
Format: Article
Language:English
Subjects:
Adult
Aged
Assisted circulation
Cardiopulmonary resuscitation
Cardiovascular
Engineering Sciences
Extracorporeal life support
Extracorporeal Membrane Oxygenation - mortality
Extracorporeal Membrane Oxygenation - trends
Extracorporeal Membrane Oxygenation - utilization
Female
Follow-Up Studies
Humans
Life Support Systems - utilization
Male
Materials
Middle Aged
Out-of-hospital cardiac arrest
Out-of-Hospital Cardiac Arrest - diagnosis
Out-of-Hospital Cardiac Arrest - mortality
Out-of-Hospital Cardiac Arrest - therapy
Prospective Studies
Retrospective Studies
Survival Rate - trends
Treatment Outcome
Ventricular fibrillation
Young Adult
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Summary: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.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2015.11.165