Extra-Corporeal Cardiopulmonary Resuscitation (ECPR) for Cardiac Arrest Patients-3-Year Experience in the Era of Left Ventricular Decompression

Abstract Background Cardiac arrest has been a great threat, regardless of its occurrence in or out of the hospital (OHCA and IHCA). ECMO has been regarded as the last resort to save these endangering lives. This prospective cohort intended to clarify how ECMO-assisted CPR (ECPR) benefited patients of cardiac arrests, both OHCA and IHCA, and addressed the survival benefit of left ventricular decompression. Methods Consecutive patients of OHCA and IHCA, refractory to resuscitation and without certain exclusion criteria for mechanical support, were enrolled since 2018. Primary endpoint was in-hospital mortality. Results From 2018 Jan. to 2021 Mar., 147 patients of both OHCA and IHCA were put on ECPR. Acute coronary syndrome took 63.3%. Rate of weaning-off from ECMO/modified LVAD was 45.6%, and the in-hospital mortality rate was 67.3%. Peak serum lactate (10.9 ± 5.5 vs. 16.4 ± 7.7 mmol/L, p < 0.001) and left ventricular ejection fraction (35.8 ± 20.6% vs. 26.7 ± 21.7%, p = 0.029) during mechanical support were of prognostic significance. The low-flow time was not correlated with these two prognostic parameters and in-hospital mortality in our series. Forty-five patients with poorer left ventricular function were put on modified LVAD, which rendered survival benefit over VA-ECMO by 3 days: 1st day mortality (VA-ECMO vs modified LVAD 18.6% vs. 2.2%, p = 0.008); 3rd day (35.3% vs 17.8%, p = 0.034). The Kaplan-Meyer analysis depicted the survival benefit of modified LVAD (log-rank p = 0.024) Conclusion Our prospective cohort, enrolling both OHCA and IHCA patients put on ECPR, implied that fair outcomes could be achieved in both groups, as long as high quality CPR could be persistently applied, regardless of the low-flow time. Peak serum lactate and LVEF were proved again to be closely correlated to outcomes. Moreover, the procedure of LV decompression could render further survival benefit to those with poorer LV function.