Experience of extracorporeal cardiopulmonary resuscitation in a refractory cardiac arrest patient at the emergency department

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a method to improve survival outcomes in refractory cardiac arrest. Hypothesis This study aimed to determine the associated factors related to outcome and to analyze the post-ECPR management in patients who received ECPR due to nonresponse to advanced cardiac life support (ACLS). Methods This was a retrospective analysis based on a prospective cohort. Cardiac arrest patients who received ECPR in our emergency department from May 2006 to December 2017 were selected from the prospective cohort. Patients who received ECPR for rearrest were excluded. The primary outcome was survival to discharge. Results ECPR was attempted in 100 patients who did not respond to ACLS. Fourteen patients survived to discharge, and 12 (85.7%) patients showed good neurologic outcomes. The rate of survival to discharge decreased according to increasing age and ACLS duration. Age, presence of any return of spontaneous circulation (ROSC) during ACLS, and prolongation of ACLS were associated factors for survival discharge in ECPR patients. Fourteen patients required distal perfusion catheters, and 35 patients received continuous renal replacement therapy (CRRT). The proportion of death was the highest within 24 hours after ECPR as 57.0%. Conclusions The early transition from ACLS to ECPR may improve the ECPR outcomes. In addition, good outcomes are expected for ECPR performed after refractory arrest if the patient is young and experiences an ROSC event during ACLS. In post ECPR management, the majority of mortality events were occurred in the early period, and distal perfusion catheter and CRRT were frequently required.