ECMO for cardiac arrest, E-CPR, has been shown several times to increase survival more than any other intervention we have available. Here’s yet another retrospective study to support the findings in previous trials (links at end of post). Survival with good neurological outcome increased from 7.5% to 40% with E-CPR!
Patients in cardiac arrest between 2011 and 2013 were examined. No-flow time <5min and age <70years and refractory VF. The conventional CPR (C-CPR) arm included patients with more than 10 mins of CPR. Findings
C-CPR gave a survival to discharge of 27.5%, but of these, only 7.5% had CPC 1-2. E-CPR had a 50% survival to discharge, with 40% having CPC 1-2!
Both groups had kept the same number of patients surviving with CPC 1-2 after 1 year, meaning C-CPR 7.5% and E-CPR 40%.
So E-CPR doubled survival compared to C-CPR in this study, but even more important: survival with good neurological outcome was more than 5 times higher in the E-CPR group!
The standard limitations to retrospective studies apply, and we can’t rule out a selection bias for patients put on ECMO – they will usually be the ones you think stand a good chance. This will also remove potential survivers from the C-CPR group. On the other hand, CPR had been going for at least 10 mins to be included in the study, and the E-CPR group had CPR for 40-50 mins before getting on pump.
In addition to this a 27.5% survival in the C-CPR group for refractory VF (>10 mins) is quite good, and 7.5% with good neurology is also not far from comparable numbers in other C-CPR studies where no ECMO selection has been involved. The 50% and 40% with good neurology survival numbers in the E-CPR group are very good, but comparable to other studies.
There’s so much evidence mounting showing these patients do so much better on VA-ECMO support than with conventional CPR, that it will be hard to ignore using your ECMO machine for E-CPR if you have one available in your institution. Some say it’s time for an RCT – but I sure wouldn’t like to end up in the C-CPR arm…
Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation, Resuscitation, 2015.