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Original Articles: Adult Cardiac

Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in Adults

^a Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
^b Department of Pediatric Critical Care Medicine, Children's Hospital and Regional Medical Center and the University of Washington, Seattle, Washington
^c Extracorporeal Life Support Organization, University of Michigan, Ann Arbor, Michigan
^d Department of Pediatrics, University of Utah, and Primary Children's Medical Center, Salt Lake City, Utah

Accepted for publication December 24, 2008.

^_* Address correspondence to Dr Thiagarajan, Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 (Email: ravi.thiagarajan{at}cardio.chboston.org).

Background: Extracorporeal membrane oxygenation (ECMO) to support cardiopulmonary resuscitation (CPR) has been shown to improve survival in children and adults. We describe outcomes after the use of ECMO to support CPR (E-CPR) in adults using multiinstitutional data from the Extracorporeal Life Support Organization (ELSO) registry.

Methods: Patients greater than 18 years of age using ECMO to support CPR (E-CPR) during 1992 to 2007 were extracted from the ELSO registry and analyzed.

Results: Two hundred and ninety-seven (11% of 2,633 adult ECMO uses) reports of E-CPR use in 295 patients were analyzed. Median age was 52 years (interquartile range [IQR], 35, 64) and most patients had cardiac disease (n = 221; 75%). Survival to hospital discharge was 27%. Brain death occurred in 61 (28%) of nonsurvivors. In a multivariate logistic regression model, pre-ECMO factors including a diagnosis of acute myocarditis (odds ratio [OR]: 0.18; 95% confidence interval [CI]: 0.05 to 0.69) compared with noncardiac diagnoses and use of percutaneous cannulation technique (OR: 0.42; 95% CI: 0.21 to 0.87) lowered odds of mortality, whereas a lower pre-ECMO arterial blood partial pressure of oxygen (PaO ₂ ) less than 70 mm Hg (OR: 2.7; 95% CI: 1.21 to 6.07) compared with a Pa O ₂ of 149 mm Hg or greater increased odds of mortality. The need for renal replacement therapy during ECMO increased odds of mortality (OR: 2.41; 95% CI: 1.34 to 4.34).

Conclusions: The use of E-CPR was associated with survival in 27% of adults with cardiac arrest facing imminent mortality. Further studies are warranted to evaluate and better define patients who may benefit from E-CPR.

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Shekar Lankala Charda Reddy
Ann. Thorac. Surg. 2009 87: 785. [Extract] [Full Text] [PDF]

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				S. L. C. Reddy Invited commentary. Ann. Thorac. Surg., March 1, 2009; 87(3): 785 - 785. [Full Text] [PDF]