10-Year Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest at a Tertiary Center

Purpose Extracorporeal cardiopulmonary resuscitation (ECPR) is controversial given the paucity of clear evidence for improved outcomes and a lack of clarity on appropriate candidacy in time-sensitive arrest situations. We set out to investigate what factors predicted successful outcomes in ECPR patients. Methods Between March 2007 and August 2018, 112 patients were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for ECPR at our institution. Primary outcomes of interest were survival to decannulation and survival to hospital discharge. Patients were compared in terms of pre-cannulation comorbidities, laboratory values, and overall outcomes. Multivariable logistic regression was performed to identify pre-cannulation predictors of in-hospital mortality. Results Among 112 patients, 44 (39%) survived to decannulation with 31 (28%) surviving to discharge. The median age was 60 (IQR 45-72 years) with a median duration of ECMO support of 2.2 days (IQR 0.6-5.1). There were no differences in age, comorbidities, or year of cannulation between those who survived to decannulation and those who did not. Patients who survived to discharge had a lower prevalence of chronic kidney disease than those who died in-hospital (19% vs. 41%, p=0.046) with lower baseline creatinine levels (median 1.2 mg/dL (IQR 0.8-1.7) vs. 1.7 (0.7-2.7), p=0.008). Median time from CPR initiation to cannulation was 40 minutes (IQR 30-50) with no differences between survivors and non-survivors (p=0.453). When controlling for age and CPR duration, multivariable logistic regression identified pre-arrest serum creatinine as predictive of mortality (OR 3.25 (95% CI: 1.22-8.70), p=0.019) while higher pre-arrest serum albumin was protective (OR 0.32 (95% CI: 0.14-0.74), p=0.007). Conclusion Despite high mortality rates, ECPR affords the opportunity to rescue patients in cardiac arrest. Reduced pre-cannulation renal function and higher serum albumin levels may have value in determining the likelihood of ECPR survival.