Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience
Résumé
Background Cardiopulmonary resuscitation displays low survival rate after out-of-hospital cardiac arrest (OHCA). Extracorporeal life support (ECLS) could be suggested as a rescue therapeutic option in refractory OHCA. The aim of this report is to analyze our experience of ECLS implantation for refractory OHCA. Methods We performed a retrospective observational analysis of our prospectively collected database. Patients were divided into a shockable rhythm (SH-R) and a non-shockable rhythm (NSH-R) group according to cardiac rhythm at ECLS implantation. The primary endpoint was survival to hospital discharge with good neurological recovery. Results From January 2010 to December 2014 we used ECLS in 68 patients (SH-R, n = 19, 27.9% vs. NSH-R, n = 49, 72.1%) for refractory OHCA. The clinical profile before ECLS implantation was comparable between the groups. Eight (11.7%) patients were successfully weaned from ECLS (SH-R = 31.5% vs. NSH-R = 4.0%, p = 0.01) after a mean period of support of 2.1 days (SH-R = 4.1 days vs. NSH-R = 1.4 days, p = 0.01). Six (8.8%) patients survived to discharge (SH-R = 31.5% vs. NSH-R = 0%, p = 0.00). In the SH-R group 50% of the survivors were discharged without neurological complications. Conclusions ECLS for refractory OHCA should be limited in consideration of its poor, especially neurological, outcome. Non-shockable rhythms could be considered as a formal contraindication allowing a concentration of our efforts on the shockable rhythms, where the chances of success are substantial. © 2015 Elsevier Ireland Ltd. All rights reserved.
Mots clés
Life Support Systems
Male
Middle Aged
Prospective Studies
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult
acute coronary syndrome
aorta dissection
Article
comparative study
controlled study
counterpulsation
embolectomy
extracorporeal circulation
extracorporeal life support
health care utilization
heart rhythm
hospital discharge
human
intraaortic balloon pump counterpulsation
lung embolism
major clinical study
non shockable rhythm
observational study
out of hospital cardiac arrest
outcome assessment
patient selection
percutaneous coronary intervention
priority journal
refractory out of hospital cardiac arrest
retrospective study
sex ratio
shockable rhythm
treatment contraindication
extracorporeal oxygenation
follow up
microclimate
mortality
Out-of-Hospital Cardiac Arrest
prospective study
trends
utilization
Adult
Aged
Extracorporeal Membrane Oxygenation
Female
Follow-Up Studies
Humans