Cardiopulmonary Resuscitation with Assisted Extracorporeal Life-Support versus Conventional Cardiopulmonary Resuscitation in Adults with In-Hospital Cardiac Arrest:
An Observational Study & Propensity Analysis
Lancet 2008; 372:554-561
- National Taiwan University Hospital, in Taipei, is an extracorporeal life-support referral centre.
- The CPR team consisted of a senior medical resident, several junior residents, a respiratory therapist, a head nurse, and several registered nurses from the ICU.
Adults with IHCA of cardiac origin (as established by 2 independent committees), aged between 18 and 75 years, who underwent CPR for longer than 10 min between Jan 1, 2004, and Dec 31, 2006.
- CPR of less than 10 min
- age over 75 years
- previously known severe irreversible brain damage
- terminal malignancy
- a traumatic origin with uncontrolled bleeding
- non-cardiac arrest
- previously signed “Do not attempt resuscitation”
The decision to discontinue unsuccessful CPR (no return of spontaneous circulation [ROSC] for 30 min) was made after communication with the family.
- Average duration from the call to team arrival was 5–7 min during the day and 15–30 min during the night shift
- If ROSC was sustained for more than 20 min after the team arrived, ECLS would not be installed.
- If was continued for less than 20 min, the team would wait at least 10 min and begin ECLS in case of reoccurrence of arrest.
- 10–15 min was usually needed to set up ECLS.
- Weaning, defined as successful separation from ECLS without mortality in 12 h, was not attempted until 72 h after initiation.
- Ventricular assist device and heart transplantation were alternatives in the absence of contraindications when weaning was unsuccessful in 5–7 days.
- Cessation of ECLS was considered if severe neurological impairment persisted for more than 7 days without signs of recovery.
17 patients in the extracorporeal group (28.8%) and 14 patients (12.3%) in the conventional group survived to discharge.
- Extracorporeal circulation had previously been applied in several critical conditions, including ARDS, cardiogenic or postcardiotomy shock, and bridge to ventricular assist device, transplantation, or next decision.
- Compared with VT or VF as the initial rhythm, those who showed PEA or asystole had higher mortality.
- The main factors associated with outcome are baseline condition, underlying cause, and the rapid response of the CPR team.
- Extracorporeal CPR might be recommended for adult IHCA of cardiac origin who have undergone CPR for more than 10 min and could provide a short-term and long-term survival advantage.