National trends in utilization and outcomes of extracorporeal support for in- and out-of-hospital cardiac arrest

Abstract

Introduction: Extracorporeal life support (ECLS) has shown promise in the management of cardiac arrest. The purpose of this study was to examine temporal trends and predictors of ECLS utilization and survival to discharge among inpatients with cardiac arrest in the United States.

Methods: All patients admitted after out-of-hospital cardiac arrest (OHCA) and those who experienced in-hospital cardiac arrest (IHCA) from 2005 to 2014 were identified in the National Inpatient Sample. Patients carrying a pregnancy as well as those with do-not-resuscitate orders or trauma-related diagnoses were excluded. Multivariable logistic regression was used to identify predictors of ECLS utilization and survival to discharge.

Results: An estimated 1,624,827 patients were identified. During the study period, use of ECLS increased from 77 to 564 per 100,000 arrests for OHCA, and 60 to 632 per 100,000 arrests for IHCA. Survival among patients on ECLS for OHCA and IHCA increased from 34.2% to 54.2% and from 4.7% to 19.2%, respectively. Age, year of arrest, cardiac rhythm, and the presence of a potentially reversible etiology including myocardial infarction and pulmonary embolism, were predictive of ECLS utilization. Among patients placed on ECLS, age, rhythm at arrest, and location of arrest were predictive of survival to discharge.

Conclusions: Mortality after cardiac arrest for those on ECLS has substantially decreased. Younger age, shockable rhythm, and out-of-hospital arrest location were predictive of survival or utilization. As ECLS use increases, it is critical to define selection criteria that maximize the benefits of ECLS.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Extracorporeal membrane oxygenation.