Prognostic Factor in Extracorporeal Cardiopulmonary Resuscitation for Refractory In- and Out-of-Hospital Cardiac...

Area of Science:

• Cardiology
• Intensive Care Medicine
• Emergency Medicine

Background:

• Extracorporeal cardiopulmonary resuscitation (ECPR) improves outcomes for refractory cardiac arrest (CA).
• ECPR involves risks like futility and high costs, necessitating rapid prognostic assessment.
• Identifying immediate prognostic factors for ECPR is crucial for effective decision-making.

Purpose of the Study:

• To evaluate prognostic factors available during conventional cardiopulmonary resuscitation (CCPR) in patients with in-hospital CA (IHCA) and out-of-hospital CA (OHCA).
• To identify predictors of 30-day mortality in ECPR recipients.

Main Methods:

• Single-center retrospective study of ECPR recipients from January 2013 to September 2024.
• Univariate and multivariate logistic analyses were performed to identify predictors of 30-day mortality.
• Analysis stratified by IHCA and OHCA patient groups.

Main Results:

• Overall 30-day survival rate was 24% among 204 ECPR patients.
• In-hospital CA patients had higher survival rates (30%) than out-of-hospital CA patients (15%).
• Optimal lactate cutoffs were 9.2 mmol/L for IHCA and 14.3 mmol/L for OHCA; lactate, initial rhythm (IHCA), out-of-hours ECPR, and bystander CPR (OHCA) were significant predictors.

Conclusions:

• Serum lactate levels before ECPR are valuable for IHCA and OHCA decision-making.
• Out-of-hours ECPR for OHCA patients requires careful consideration.
• Further research is needed to validate these findings and define optimal ECPR candidates.