Morgan Le Guen , Armelle Nicolas-Robin , Serge Carreira , Mathieu Raux , Pascal Leprince , Bruno Riou and Olivier Langeron. Critical Care 2011, 5:R29doi:10.1186/cc9976. Published: 18 January 2011
Introduction
Extracorporeal life support (ECLS) has recently shown encouraging results in resuscitation of in-hospital (IH) refractory cardiac arrest. We assessed the use of ECLS following out-hospital (OH) refractory cardiac arrest.
Methods
We evaluated 51 consecutive patients who experienced witnessed OH refractory cardiac arrest and received automated chest compression and ECLS upon arrival in the hospital. Patients with pre-existing severe hypothermia and who experienced IH cardiac arrest were excluded. A femoro-femoral ECLS was set up on admission to hospital by a mobile cardiothoracic surgical team.
Results
51 patients were included, mean age 42 + 15 years. The mean delays from arrest to cardiopulmonary resuscitation and ECLS were respectively 3 [25-75 interquartile 1-7] and 120 [102-149] min. Initial rhythm was ventricular fibrillation in 32 (63%) patients, asystole in 15 (29%) patients, and pulseless rhythm in 4 (8%). ECLS failed in 9 (18%) patients. Only two (4%, 95% confidence interval 1-13%) patients were alive at day 28 with a favourable neurological outcome. There was a significant correlation (R=0.36, p=0.01) between blood lactate and delay between cardiac arrest and onset of ECLS, but not with arterial pH or blood potassium. Deaths were the consequence of multi-organ failure (n=43, 47%), brain death (n=10, 20%) and refractory hemorrhagic shock (n=7, 14%), and most patients (n=46, 90%) died within 48 hours.
Conclusions
This poor outcome suggests that the use of ECLS should be more restricted following in OH refractory cardiac arrest.
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