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Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation

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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.

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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

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Authors and Affiliations

  1. Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany

    Christian Jung, Kyra Janssen, Tudor Constantin Poerner, Michael Fritzenwanger, Ruediger Pfeifer & Hans Reiner Figulla

  2. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany

    Mirko Kaluza

  3. Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany

    Georg Fuernau & Holger Thiele

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  1. Christian Jung
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Correspondence to Christian Jung.

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Jung, C., Janssen, K., Kaluza, M. et al. Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation. Clin Res Cardiol 105, 196–205 (2016). https://doi.org/10.1007/s00392-015-0906-4

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