Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest

• Published in: Clinical research in cardiology Vol. 102; no. 9; pp. 661 - 669
• Main Authors: Leick, Jürgen, Liebetrau, Christoph, Szardien, Sebastian, Fischer-Rasokat, Ulrich, Willmer, Matthias, van Linden, Arnaud, Blumenstein, Johannes, Nef, Holger, Rolf, Andreas, Arlt, Matthias, Walther, Thomas, Hamm, Christian, Möllmann, Helge
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2013; Springer Nature B.V
• Subjects: Adult; Aged; Cardiology; Cardiopulmonary Resuscitation - mortality; Chi-Square Distribution; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - instrumentation; Extracorporeal Membrane Oxygenation - mortality; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Original Paper; Out-of-Hospital Cardiac Arrest - diagnosis; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - physiopathology; Out-of-Hospital Cardiac Arrest - therapy; Patient Admission; Proportional Hazards Models; Recovery of Function; Retrospective Studies; Risk Factors; Stroke Volume; Survival Rate; Time Factors; Time-to-Treatment; Treatment Outcome; Ventricular Function, Left; Out-of-hospital cardiac arrest; Cardiopulmonary resuscitation; Extracorporeal life support
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-013-0580-3

Objective This study aimed to identify predictors of mortality in patients with out-of-hospital cardiac arrest (OHCA) undergoing in-hospital extracorporeal life support system (ECLS) treatment. Methods We retrospectively studied the characteristics and clinical outcomes of 28 patients (January 2010 and December 2011) with OHCA and veno-arterial ECLS implemented during ongoing cardiopulmonary resuscitation (CPR) upon admission to the cath lab. Baseline left ventricular ejection fraction (LVEF) was determined after ECLS implantation and then every 24 h during and after successful weaning from ECLS. Results Overall 30-day survival rate was 39.3 % (11 of 28 patients). Baseline characteristics, initial laboratory measurements, and LVEF on admission were not significantly different between survivors and non-survivors. There was no difference regarding median CPR duration [survivors 44.0 min (IQR 31.0-45.0) vs. non-survivors 53.0 min (IQR 40.0-61.3); P  = 0.23]. Door-to-ECLS implantation time was significantly longer in non-survivors [42.5 min (IQR 28.0–56.5) vs. 25.0 min (IQR 21.0–30.0); P  < 0.01]. ECLS treatment duration was not significantly different between the two groups [survivors: 4.0 days (IQR 1.5–7.5) vs. non-survivors 6.5 days (IQR 1.0–8.0); P  = 0.69]. LVEF significantly improved in survivors during ECLS treatment (mean ± SD survivor 47.5 ± 14.7 % vs. non-survivor 23.3 ± 14.9 %; P  < 0.01). The door-to-ECLS implantation time was the only significant and independent predictor of 30-day mortality in multivariate Cox regression analysis ( P  = 0.04). Kaplan–Meier survival analysis showed a benefit favouring patients with a door-to-ECLS implantation time <30 min (log rank 6.29; P  = 0.01). Conclusion A door-to-ECLS implantation time <30 min significantly improves 30-day outcomes in patients with OHCA.