Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation*

• DOI: 10.1097/ccm.0b013e3181feb339
• Publication Date: 2010-11-06T02:14:30Z
• Authors: Tae Gun Shin; Jin-Ho Choi; Ik Joon Jo; Min Seob Sim; Hyoung Gon Song; Yeon Kwon Jeong; Yong-Bien Song; Joo-Yong Hahn; Seung Hyuk Choi; Hyeon-Cheol Gwon; Eun-Seok Jeon; Kiick Sung; Wook Sung Kim; Young Tak Lee
• Keywords: Adult; Aged, 80 and over; Male; Inpatients; Korea; Adolescent; Kaplan-Meier Estimate; Middle Aged; Cardiopulmonary Resuscitation; Heart Arrest; 3. Good health; Cohort Studies; Hospitals, University; 03 medical and health sciences; Extracorporeal Membrane Oxygenation; 0302 clinical medicine; Multivariate Analysis; Confidence Intervals; Humans; Female; Hospital Mortality; Aged; Follow-Up Studies

We investigated whether the survival of patients with inhospital cardiac arrest could be extended by extracorporeal cardiopulmonary resuscitation supported with extracorporeal membrane oxygenation compared with those of conventional cardiopulmonary resuscitation.: A retrospective, single-center, observational study.A tertiary care university hospital.We retrospectively analyzed a total of 406 adult patients with witnessed inhospital cardiac arrest receiving cardiopulmonary resuscitation for >10 mins from January 2003 to June 2009 (85 in the extracorporeal cardiopulmonary resuscitation group and 321 in the conventional cardiopulmonary resuscitation group).None.The primary end point was a survival discharge with minimal neurologic impairment. Propensity score matching was used to balance the baseline characteristics and cardiopulmonary resuscitation variables that could potentially affect prognosis. In the matched population (n = 120), the survival discharge rate with minimal neurologic impairment in the extracorporeal cardiopulmonary resuscitation group was significantly higher than that in the conventional cardiopulmonary resuscitation group (odds ratio of mortality or significant neurologic deficit, 0.17; 95% confidence interval, 0.04-0.68; p = .012). In addition, there was a significant difference in the 6-month survival rates with minimal neurologic impairment (hazard ratio, 0.48; 95% confidence interval, 0.29-0.77; p = .003; p <.001 by stratified log-rank test). In the subgroup based on cardiac origin, extracorporeal cardiopulmonary resuscitation also showed benefits for survival discharge (odds ratio, 0.19; 95% confidence interval, 0.04-0.82; p = .026) and 6-month survival with minimal neurologic impairment (hazard ratio, 0.56; 95% confidence interval, 0.33-0.97; p = .038; p = .013 by stratified log-rank test).Extracorporeal cardiopulmonary resuscitation showed a survival benefit over conventional cardiopulmonary resuscitation in patients who received cardiopulmonary resuscitation for >10 mins after witnessed inhospital arrest, especially in cases with cardiac origins.