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Int J Cardiol. 2016 Feb 1;204:70-6. doi: 10.1016/j.ijcard.2015.11.165. Epub 2015 Nov 25.

Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience.

Author information

1
Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France. Electronic address: mpozzi1979@gmail.com.
2
Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
3
Division of Clinical Research and Innovation, Innovation Department/UMR CNRS 5510 MATEIS, Equipe I2B, Lyon, France.
4
Department of Cardiology, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
5
Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.

Abstract

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.

KEYWORDS:

Assisted circulation; Cardiopulmonary resuscitation; Extracorporeal life support; Out-of-hospital cardiac arrest; Ventricular fibrillation

PMID:
26655543
DOI:
10.1016/j.ijcard.2015.11.165
[Indexed for MEDLINE]

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