Eastern Cardiothoracic Surgical Society

Characteristics Influencing Outcomes in Patients Who Undergo Extracorporeal Membrane Oxygenation After Cardiopulmonary Resuscitation
Amber Melvin, Peter Knight, Joshua Wong. University of Rochester, Rochester, NY USA.


Objective: It is well established that patients with cardiac arrest related to cardiogenic shock are at high risk for mortality. Often venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used in these patients as a life-saving measure. We analyzed this population to review outcomes and determine pre-ECMO characteristics that may confer survival benefit.

Methods: This is a retrospective review of patients treated with VA-ECMO after CPR from January 2010-2015; post-cardiotomy patients were excluded. The mean age of the population was 53.0. (Table SA13-1) The primary outcome was survival until ECMO termination, whether to ECMO wean or intervention. Pre-ECMO characteristics that were analyzed include pH, lactate, time from CPR to ECMO initiation, and pre-ECMO ejection fraction.

Results: A total of 103 VA-ECMO patients were identified, of which 47 (45.6%) had CPR prior to ECMO. Patients with pH7.25 had 70% (16/22) survival (OR 3.8095, CI 0.99-14.6, p 0.05). There were no survivors with pH<7.0 (4/39). Patients who survived had no statistically significant difference in pre-ECMO lactate levels, ejection fraction, or time from CPR to ECMO initiation from nonsurvivors. There was no statistically significant survival difference in patients who underwent CPR prior to ECMO compared to those who did not.

Conclusions: Patients with pH < 7.25 have inferior survival; furthermore patients with pH <7.0 have 0% survival although the population is small. It may be advisable to avoid ECMO in patients with pH <7.25. Interestingly the time from CPR to ECMO was not statistically significant.

Table 1 – Pre-ECMO Patient Demographics
Survival
(n=22)
  Non-survival
(n=17)
  P value
Age 54.67   51.11 0.470
Sex - Male 13 (59%)   14 (82%) 0.169
Diabetes Mellitus 3 (14%)   3 (18%) 1.000
Hypertension 12 (55%)   6 (35%) 0.334
Hyperlipidemia 6 (27%)   7 (41%) 0.497
Prior CVA 0 (0%)   3 (18%) 0.074
PVD 0 (0%)   0 (0%) 1.000
History of Chronic
Renal Injury
0 (0%   0 (0%) 1.000