Extracorporeal Cardiopulmonary Resuscitation (E-CPR) - 8 Years of Experience

Purpose Post-cardiac arrest outcomes like survival to discharge and neurological recovery remain low despite improved medical care and technology. Nationally, traditional methods show that Methods Between 2010 and 2018, a total of 230 ECMO procedures were performed at our institution and 34 cases had E-CPR after traditional measures were inadequate. Patient demographics, ECMO survival, survival to discharge, and neurological recovery were retrospectively analyzed with IRB approval. Results Of the 34 patients who received E-CPR, there were 21 males and 13 females, with a mean age of 49 ± 13 years. The mean duration of ECMO support was 8.3 ± 7.9 days. The indications (#) for E-CPR in these patients were: acute myocardial infarction (15), malignant arrhythmia (6), myocarditis (2), acute pulmonary emboli (2), hypothermia (2), post-cardiotomy failure (2), and others (5). 11 of 34 (32%) patients died during ECMO from: anoxic brain injury (4), stroke (4), withdrawn care (2), and bowel necrosis (1). Additionally, 10 patients died after ECMO decannulation due to anoxic brain injury (5), sepsis (3), ventricular fibrillation (1), withdrawn care (1). E-CPR survival to discharge overall was 13/34 (38%) with full neurological recovery in all patients. ECMO survival rate and 30-days survival rate was improved from (63%, 15/24 and 25%, 6/24) early half of study (2010-2014) to (70%, 7/10 and 60%, 6/10) in late half of study (2014-2018). Among patients with anoxic brain injury that expired during E-CPR, 2/4 (50%) provided multiple organ procurement. Conclusion Over years of experience with ECMO, the outcome of the E-CPR has been improving and appears to exceed those of traditional methods, despite limited sample size. Multiple organ procurement appears to provide a minor added benefit. Neurological complications still need to be addressed in order for survival and outcomes to improve.