1887
Volume 2017, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of extracorporeal membrane oxygenation (ECMO) – or cardiopulmonary bypass – to provide immediate cardiovascular support for patients who have cardiac arrest unresponsive to conventional cardiopulmonary resuscitation (CPR) measures.

There is improved survival with isolated cardiac lesions.1 Cardiac disease (adjusted for confounding factors) was associated with improved survival when compared with non-cardiac diseases (odds ratio 6.3, 2.01–19.80).2

Conventional CPR versus ECPR has a lower survival to discharge 8.2–22% and about 6–11% for critically ill patients. The survival of out-of-hospital cardiac arrest is less than 3%.3 The long-term survival is 53% with ECPR versus 17% with conventional CPR.4 ECPR in witnessed in-hospital cardiac arrest in areas of advanced life support system and effective CPR with single organ dysfunction with minimum time elapse in logistics like ECPR in cath lab is associated with much better patient outcome and revival to hospital discharge. Procedural support for angioplasty, arrhythmia ablation, pulmonary embolectomy, and bypass surgery are few examples of crash down situations, which are better managed with ECPR. A cath lab is the best place for application of ECMO in a short time. The equipment consists of the ECMO circuit with a centrifugal pump, hollow fiber oxygenator, heat exchanger, back up battery, 3/8 inch venous quick prime tubing, arterial tubing, and percutaneous arterial and venous cannulas. This is a study of 16 cases of ECPR done in a cath lab for witnessed adult cardiac arrests. The decision to initiate ECPR was done in 5 min with circuit priming within 20 min, and simultaneous cannulation performed in 15 min by another team. Overall, 16 patients with cardiac disease over a period of 3 years were included in this study. The age group varied from 35 to 70 years. There were 12 males and 4 females. Six patients had poor left ventricle (LV) with heart failure, who were undergoing bypass surgery. Seven patients had acute myocardial infarction (MI) with cardiac arrest, who were considered for primary angioplasty (PAMI). Two patients had malignant arrhythmias (post-viral) and one patient had pulmonary embolism. There was 8/16 (50%) survival at least 24 h after ECMO decannulation and 5/16 (33%) survival to hospital discharge. Two patients could not be weaned off ECMO support. The most common cause of death was ischemic brain injury. All the survivors had favorable neurological outcome. Two patients had CPR of 60 min prior to ECPR. Pre-arrest factors associated with non-survival were persistent hypotension and renal insufficiency. ECPR promotes survival with ECMO application. Pre-ECMO quality of resuscitation will influence success percentage. Functional outcomes in survivors were reasonable with few derangements, particularly neurological impairments. All procedures were uncomplicated following ECMO application.

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/content/journals/10.5339/qmj.2017.swacelso.28
2017-02-14
2019-09-20
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