Impact of clinical variables on outcomes in refractory cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation

Simon-Pierre Demers; Alexis Cournoyer; Olina Dagher; Pierre-Emmanuel Noly; Anique Ducharme; Hung Ly; Martin Albert; Karim Serri; Yiorgos Alexandros Cavayas; Walid Ben Ali; Yoan Lamarche

doi:10.3389/fcvm.2023.1315548

Impact of clinical variables on outcomes in refractory cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation

Front Cardiovasc Med. 2024 Jan 5:10:1315548. doi: 10.3389/fcvm.2023.1315548. eCollection 2023.

Authors

Simon-Pierre Demers^{1

2}, Alexis Cournoyer^{1

3}, Olina Dagher^{1

4

5}, Pierre-Emmanuel Noly^{1

4

6}, Anique Ducharme^{1

2

6}, Hung Ly^{1

2

6}, Martin Albert^{1

4

7}, Karim Serri^{1

4

7}, Yiorgos Alexandros Cavayas^{1

4

7}, Walid Ben Ali^{1

6}, Yoan Lamarche^{1

6

7}

Affiliations

¹ Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
² Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada.
³ Department of Emergency Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.
⁴ Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada.
⁵ Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, AB, Canada.
⁶ Research Center, Montreal Heart Institute, Montreal, QC, Canada.
⁷ Department of Medicine, Critical Care, Hôpital du Sacré-Cœur de Montréal and CIUSSS NIM Research Center, Montreal, QC, Canada.

Abstract

Background: In the past two decades, extracorporeal resuscitation (ECPR) has been increasingly used in the management of refractory cardiac arrest (CA) patients. Decision algorithms have been used to guide the care such patients, but the effectiveness of such decision-making tools is not well described. The aim of this study was to compare the rate of survival with a good neurologic outcome of patients treated with ECPR meeting all criteria of a clinical decision-making tool for the initiation of ECPR to those for whom ECPR was implemented outside of the algorithm.

Methods: All patients who underwent E-CPR between January 2014 and December 2021 at the Montreal Heart Institute were included in this retrospective analysis. We dichotomized the cohort according to adherence or non-adherence with the ECPR decision-making tool, which included the following criteria: age ≤65 years, initial shockable rhythm, no-flow time <5 min, serum lactate <13 mmol/L. Patients were included in the "IN" group when they met all criteria of the decision-making tool and in the "OUT" group when at least one criterion was not met.

Main outcomes and measures: The primary outcome was survival with intact neurological status at 30 days, defined by a Cerebral Performance Category (CPC) Scale 1 and 2.

Results: A total of 41 patients (IN group, n = 11; OUT group, n = 30) were included. A total of 4 (36%) patients met the primary outcome in the IN group and 7 (23%) in the OUT group [odds ratio (OR): 1.88 (95% CI, 0.42-8.34); P = 0.45]. However, survival with a favorable outcome decreased steadily with 2 or more deviations from the decision-making tool [2 deviations: 1 (11%); 3 deviations: 0 (0%)].

Conclusion and relevance: Most patients supported with ECPR fell outside of the criteria encompassed in a clinical decision-making tool, which highlights the challenge of optimal selection of ECPR candidates. Survival rate with a good neurologic outcome did not differ between the IN and OUT groups. However, survival with favorable outcome decreased steadily after one deviation from the decision-making tool. More studies are needed to help select proper candidates with refractory CA patients for ECPR.

Keywords: ECPR; cardiac arrest; cardiac intensive care; cardiopulmonary resuscitation; extracorporeal circulation.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.