Ten-year outcomes of extracorporeal life support for in-hospital cardiac arrest at a tertiary center
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ORIGINAL ARTICLE Cardiopulmonary Bypass
Ten‑year outcomes of extracorporeal life support for in‑hospital cardiac arrest at a tertiary center Michael Salna1 · Joseph Sanchez1 · Justin Fried2 · Amirali Masoumi2 · Lucas Witer1 · Paul Kurlansky1 · Cara L. Agerstrand3 · Daniel Brodie3 · A. Reshad Garan4 · Koji Takeda1 Received: 29 December 2019 / Accepted: 12 June 2020 © The Japanese Society for Artificial Organs 2020
Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) is controversial, given both the lack of evidence for improved outcomes and clarity on appropriate candidacy during time-sensitive cardiac arrest situations. The primary objective of our study was to identify factors predicting successful outcomes in ECPR patients.Between March 2007 and November 2018, 112 patients were placed on extracorporeal life support (ECLS) during active CPR (ECPR) at our institution. The primary outcome was survival to hospital discharge. Survivors and non-survivors were compared in terms of pre-cannulation comorbidities, laboratory values, and overall outcomes. Multivariable logistic regression was used to identify pre-cannulation predictors of in-hospital mortality. Among 112 patients, 44 (39%) patients survived to decannulation and 31 (28%) survived to hospital discharge. The median age was 60 years (IQR 45–72) with a median ECLS duration of 2.2 days (IQR 0.6–5.1). Patients who survived to discharge had lower rates of chronic kidney disease than non-survivors (19% vs. 41%, p = 0.046) and lower baseline creatinine values [median 1.2 mg/dL (IQR 0.8–1.7) vs. 1.7 (0.7–2.7), p = 0.008]. Median duration from CPR initiation to cannulation was 40 min (IQR 30–50) with no difference between survivors and non-survivors (p = 0.453). When controlling for age and CPR duration, multivariable logistic regression with pre-procedural risk factors identified pre-arrest serum creatinine as an independent predictor of mortality [OR 3.25 (95% CI 1.22–8.70), p = 0.019] and higher pre-arrest serum albumin as protective [OR 0.32 (95% CI 0.14–0.74), p = 0.007]. In our cohort, pre-arrest creatinine and albumin were independently predictive of in-hospital mortality during ECPR, while age and CPR duration were not. Keywords ECPR · ECMO · Cardiac arrest · Cardiogenic shock
Introduction
* Koji Takeda [email protected] 1
Division of Cardiothoracic Surgery, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, 177 Fort Washington Ave, Milstein Hospital Building, 7GN‑435, New York, NY 10032, USA
2
Division of Cardiology, Columbia University Medical Center, New York, NY, USA
3
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
4
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Contrary to popular belief, in-hospital cardiac arrest (IHCA) carries a high mortality rate with rates of survival to discharge just over 15% [1]. Failure to establish return of spontaneous cir
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