Experiences of Using Extracorporeal Life Support in Cardiac Arrest Unresponsive to Standard Cardiopulmonary Resuscitation

ABSTRACT

PURPOSE: Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We analyzed the cases of patients who received ECPR in our institute to find indicators for ECPR. METHODS: Patients who received ECPR in the emergency department of Korea University Ansan hospital from April 2006 to March 2007 were candidates for enrolment. Inclusion criteria were 1) a witnessed sudden cardiac arrest with correctable cause, 2) age <75 years, 3) cardiac arrest unresponsive to standard CPR, 4) absence of serious underlying disease such as advanced cancer, 5) impending arrest state due to respiratory failure or cardiogenic shock. Cardiac arrest related to trauma was excluded from the study. Tracked outcomes were hospital survival, improvement of Glasgow Coma Scale-motor respones, and return of spontaneous circulation. We analyzed the cause of arrest, arrest rhythm, time of administration of extracorporeal life support, and laboratory values. RESULTS: A total of seven patients received ECPR during one year. All patients achieved spontaneous circulation after ECPR and four patients showed improvement of GCS-motor response. Two patients were discharged alive. Their GCS and CPC were 15 points and 1 point, respectively. Intervention to correct underlying cause of arrest during ECPR, rapid start of ECPR during chest compression, and recovery of mean arterial pressure, heart rate, and urine output during ECPR all correlated with good outcomes. CONCLUSION: ECPR as a method of extended CPR improved the survival of cardiac arrest patients unresponsive to standard CPR.