Terri Sun1, Andrew Guy2, Amandeep Sidhu3, Gordon Finlayson4, Brian Grunau5, Lillian Ding6, Saida Harle6, Leith Dewar7, Richard Cook7, Hussein D Kanji8. 1. Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver General Hospital, Rm 330, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada. Electronic address: terri.sun@alumni.ubc.ca. 2. Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, V6T 1Z3 Vancouver, British Columbia, Canada. 3. Perfusion Services, Vancouver General Hospital, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada. 4. Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver General Hospital, Rm 330, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada; Department of Medicine, Division of Critical Care, Faculty of Medicine, University of British Columbia, Critical Care, Vancouver General Hospital, 2438-855 West 12th Avenue, V5Z 1M9 Vancouver, British Columbia, Canada. 5. Department of Emergency Medicine, University of British Columbia, Rm 3300, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada. 6. Cardiac Services BC, Provincial Health Services Authority, 700-1380 Burrard Street, V6Z 2H3 Vancouver, British Columbia, Canada. 7. Cardiovascular Surgery, Faculty of Medicine, University of British Columbia, Cardiac Surgery, Vancouver General Hospital, 950 West 10th Avenue, V5Z 1M9 Vancouver, British Columbia, Canada. 8. Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, V6T 1Z3 Vancouver, British Columbia, Canada; Department of Medicine, Division of Critical Care, Faculty of Medicine, University of British Columbia, Critical Care, Vancouver General Hospital, 2438-855 West 12th Avenue, V5Z 1M9 Vancouver, British Columbia, Canada.
Abstract
PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. MATERIALS AND METHODS: A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1-2). RESULTS: There were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPR patients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CS patients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPR patients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition. CONCLUSION: The initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes.
PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. MATERIALS AND METHODS: A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomypatients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1-2). RESULTS: There were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPRpatients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CSpatients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPRpatients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition. CONCLUSION: The initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes.
Authors: Michael M Koerner; Michael D Harper; Christopher K Gordon; Douglas Horstmanshof; James W Long; Michael J Sasevich; James D Neel; Aly El Banayosy Journal: Ann Cardiothorac Surg Date: 2019-01