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CLINICAL STUDY: CARDIAC ARREST AND PULMONARY EDEMA

Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation

^* Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Manuscript received March 27, 2002; revised manuscript received July 11, 2002, accepted September 20, 2002.

^* Reprint requests and correspondence: Dr. Yih-Sharng Chen, Department of Cardiothoracic Surgery, National Taiwan University Hospital, 7 Chung-Shan S. Road, Taipei 100, Taiwan, China.
yschen11{at}yahoo.com.tw

OBJECTIVES: We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) with extracorporeal membrane oxygenation (ECMO) and the predictive factors for hospital discharge and ECMO weaning.

BACKGROUND: Prolonged CPR carries considerable associated mortality and morbidity. As yet, ECMO for prolonged CPR has no definite results. Only small groups of patients and no detailed analysis have been reported.

METHODS: Candidates for ECMO resuscitation were patients in cardiac arrest receiving CPR >10 min without return of spontaneous circulation and no absolute contraindication. Venoarterial ECMO was set up during CPR. We reviewed the data of 57 prolonged CPR patients who received ECMO during CPR over a six-year period.

RESULTS: The mean duration of CPR was 47.6 ± 13.4 min and that of ECMO was 96.1 ± 87.9 h. The rate of weaning was 66.7%, and the survival rate was 31.6%. Multiple-organ failure was the major reason for mortality, despite successful weaning. Among survivors, long-term follow-up revealed 88.9% survival, and only 5.6% had a severe neurologic deficit. The results indicate that a shorter CPR duration, postcardiotomy arrest, myocardial indicators, a hepatic indicator, and lactic acid are significantly correlated with both weaning and survival, whereas late damage (level on the third or seventh day of reperfusion) rather than initial damage (level on the first day) was more predictive of the results.

CONCLUSIONS: Prolonged CPR rescue by ECMO provides an acceptable survival rate and outcome in survivors. Our results of the selected cases encourage further investigations of the wider application of ECMO in CPR.

Abbreviations and Acronyms   ACLS   advanced cardiopulmonary life support   AST   aspartate aminotransferase   CK(-MB)   creatine kinase (MB fraction)   CPB   cardiopulmonary bypass   CPR   cardiopulmonary resuscitation   Cre   creatinine   ECMO   extracorporeal membrane oxygenation   ECPR   ECMO during CPR   LA   lactic acid   VF   ventricular fibrillation   VT   ventricular tachycardia

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