Feasibility of Extracorporeal Life Support for Out-of-Hospital Cardiac Arrest Patients who are Unresponsive to Conventional Cardiopulmonary Resuscitation

Abstract

Purpose: To determine the feasibility of using extracorporeallife support (ECLS) for out-of-hospital cardiac arrest(OHCA) patients who are unresponsive to conventional cardiopulmonaryresuscitation (CPR) techniques. Methods: This study was a case series of consecutive nontraumaticOHCA patients aged 18~75 years who receivedECLS in the emergency department (ED) of a universityteaching hospital. We analyzed outcomes, physiologiceffects, and complications associated with ECLS. To compareoutcomes of ECLS and conventional CPR, we selecteda conventional CPR subgroup, those who were aged 18to 75 years, who experienced cardiac arrest with pre-hospitalCPR, who had no terminal illness, and who had CPR formore than 40 minutes. Results: Of 14 attempts to initiate ECLS, 13 patientsreceived ECLS and one patient failed catheterization. Ninepatients achieved return of spontaneous circulation (ROSC)more than 20 minutes later; 4 of the 9? patients survivedmore than 24 hours; 2 patients were successfully weanedoff ECLS; 1 patient was discharged alive without neurologiccomplications. Median (minimum-maximum) duration ofCPR before ECLS (pre-hospital and in-hospital) was 84(41to 167) minutes. Blood gas parameters obtained 3 hoursafter the start of ECLS were significantly improved comparedwith those obtained pre-ECLS. Four patients whoarrested from acute myocardial infarction received interventionas during ECLS support to correct the causes of thearrest. Serious complications of ECLS causing mortalitywere catheterization failure, intracranial hemorrhage, andmassive hemothorax. The ECLS group showed a higherROSC rate than patients who received conventional CPRwithout ECLS (64.3% vs. 7.1%, p=0.002). Conclusion: ECLS in the ED is feasible for OHCA patientswho are unresponsive to prolonged CPR. ECLS provides abridge to evaluation and definitive care in refractory OHCA byimproving early hemodynamic and physiologic status. Earlierapplication of ECLS and reduction of complications associatedwith ECLS may improve the survival of OHCA patients.