ECMO May Improve Survival in Out-of-Hospital Refractory VT/VF Cardiac Arrest

A quarter of patients with out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) cardiac arrest were found to survive to hospital discharge if they were treated with extracorporeal cardiopulmonary resuscitation (ECPR), according to a study published in the Journal of Interventional Cardiology.

This retrospective study was an assessment of complications associated with a collaborative ECPR program developed at the Ohio State University Wexner Medical Center and Columbus Division of Fire for patients with out-of-hospital refractory pulseless VT and/or VF cardiac arrest.

A total of 16 patients with refractory pulseless VT and/or VF resulting from different underlying pathologies who were eligible for ECPR were included in this study. These patients were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL).

A total of 4 patients (25%) who underwent ECPR survived to hospital discharge with cerebral perfusion category 1 or 2. Death in the remaining 12 patients was attributable to severe anoxic brain injury (n=9), refractory cardiac arrest in the CCL (n=1), aortic rupture in the CCL (n=1), or predominantly multiorgan failure (n=1). Patients who survived after ECPR tended to be younger (48.0±16.7 vs 59.3±12.7 years, respectively; P =.28).

Overall, the duration on ECMO was 3.8±2.2 days, and the total hospital days were 8.1±6.7. No significant difference was found between survivors and nonsurvivors in terms of ECMO duration (4.8±2.5 vs 3.4±2.2 days, respectively; P =.38). Survivors had a greater number of total hospital days compared with nonsurvivors (15.5±4.7 vs 5.7±5.4 days, respectively; P ≤.05).

In this cohort, 38% of patients underwent percutaneous coronary intervention (PCI). There were no significant differences between survivors and nonsurvivors in time between emergency medical services dispatch and CCL arrival (45.3±6.1 vs 43.8±10.3 minutes, respectively; P =.74), lactate levels in CCL (11.2±3.1 vs 12.2±2.5 mg/d, respectively L; P =.61), coronary artery disease severity (P =.28), occurrence of PCI (P =1.0), and pre-ECMO partial pressure of oxygen (75 vs 84 mmHg, respectively; P =.71), pre-ECMO pH (7.05±0.15 vs 7.10±0.13 g/dL, respectively; P =.53), and pre-ECMO hemoglobin levels (13.6±2.7 vs 12.8±2.8 g/dL, respectively; P =.63).

Limitations of this study include the lack of randomization.

“Multidisciplinary collaboration is critical for a successful program. In addition to CAD, the underlying pathology of VT/VF cardiac arrest was found to be due to other pathologies, which can successfully recover,” noted the study authors.

Reference

Boudoulas KD, Whitson BA, Keseg DP, et al. Extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest due to pulseless ventricular tachycardia/fibrillation. J Interv Cardiol. Published July 17, 2020. doi:10.1155/2020/6939315