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Clinical Research in Cardiology

, Volume 105, Issue 3, pp 196–205 | Cite as

Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation

  • Christian JungEmail author
  • Kyra Janssen
  • Mirko Kaluza
  • Georg Fuernau
  • Tudor Constantin Poerner
  • Michael Fritzenwanger
  • Ruediger Pfeifer
  • Holger Thiele
  • Hans Reiner Figulla
Original Paper

Abstract

Introduction

Cardiac arrest is the major cause of sudden death in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) employs extracorporeal membrane oxygenation (ECMO) in patients without return of spontaneous circulation (ROSC) by conventional cardiopulmonary resuscitation (CPR). Aim of the current study was to assess short- and long-term outcome in patients treated with ECPR in our tertiary center and to identify predictors of outcome.

Methods

We retrospectively collected data of all patients treated with ECPR at our institution from 2002 to 2013. Outcome was assessed according to patient records; good neurological outcome was defined as cerebral performance category 1 or 2. Quality of life data was collected using EQ-5 questionnaire. Uni- and multivariate analysis was applied to identify predictors of outcome.

Results

One-hundred and seventeen patients were included into the study. Weaning from ECMO was successful in 61 (52 %) patients. Thirty-day survival endpoint was achieved by 27 (23 %) patients. Good neurological outcome was present in 17 (15 %) patients. Multivariate analysis revealed baseline serum lactate as the strongest predictor of outcome, whereas age and out-of-hospital CPR did not predict outcome. The optimal lactate cut-off to discriminate outcome was determined at 4.6 mmol/l [HR 3.55 (2.29–5.49), p < 0.001, log-rank test].

Conclusion

ECPR represents a treatment option in patients without ROSC after conventional CPR rescuing 15 % of patients with good neurological outcome. Serum lactate may play a crucial role in patient selection for ECPR.

Keywords

ECMO CPR Resuscitation Outcome 

Abbreviations

ACS

Acute coronary syndrome

CA

Cardiac arrest

CPC

Cerebral performance category

CPR

Cardiopulmonary resuscitation

ECPR

Extracorporeal cardiopulmonary resuscitation

ECMO

Extracorporeal membrane oxygenation

HRQoL

Health related quality of life

IH

In-hospital (cardiac arrest)

OH

Out-of-hospital (cardiac arrest)

PCI

Percutaneous coronary intervention

ROSC

Return of spontaneous circulation conventional

Notes

Compliance with ethical standards

Conflict of interest

All authors have no conflicts to declare.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Christian Jung
    • 1
    Email author
  • Kyra Janssen
    • 1
  • Mirko Kaluza
    • 2
  • Georg Fuernau
    • 3
  • Tudor Constantin Poerner
    • 1
  • Michael Fritzenwanger
    • 1
  • Ruediger Pfeifer
    • 1
  • Holger Thiele
    • 3
  • Hans Reiner Figulla
    • 1
  1. 1.Clinic of Internal Medicine IJena University Hospital, Friedrich Schiller UniversityJenaGermany
  2. 2.Department of Cardiothoracic SurgeryJena University Hospital, Friedrich Schiller UniversityJenaGermany
  3. 3.Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care MedicineUniversity Heart Center LuebeckLübeckGermany

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