Extracorporeal Membrane Oxygenation Pathway for Management of Refractory Cardiac Arrest: A Retrospective Study from A National Center of Extracorporeal Cardiopulmonary Resuscitation

Ahmed Labib Shehatta; Rasha Kaddoura; Bassant Orabi; Mohamed Izham Mohamed Ibrahim; Ayman El-Menyar; Sumaya Alsaadi Alyafei; Abdulaziz Alkhulaifi; Abdulsalam Saif Ibrahim; Ibrahim Fawzy Hassan; Amr S Omar

doi:10.1097/HPC.0000000000000352

Extracorporeal Membrane Oxygenation Pathway for Management of Refractory Cardiac Arrest: A Retrospective Study from A National Center of Extracorporeal Cardiopulmonary Resuscitation

Crit Pathw Cardiol. 2024 Feb 20. doi: 10.1097/HPC.0000000000000352. Online ahead of print.

Authors

Ahmed Labib Shehatta^{1

2}, Rasha Kaddoura³, Bassant Orabi³, Mohamed Izham Mohamed Ibrahim⁴, Ayman El-Menyar^{2

5}, Sumaya Alsaadi Alyafei³, Abdulaziz Alkhulaifi⁵, Abdulsalam Saif Ibrahim^{1

2}, Ibrahim Fawzy Hassan^{1

2}, Amr S Omar^{2

5

6}

Affiliations

¹ Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Doha, Qatar; ashehatta@hamad.qa (AL); aibrahim1@hamad.qa (AS) ; ihassan@hamad.qa (IH).
² Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
³ Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar, RKaddoura@hamad.qa (RK) ; bassantorabi@yahoo.com (BO); salsaadi1@hamad.qa (SA).
⁴ Clinical Pharmacy and Practice Department. College of Pharmacy, Qatar University, Doha, Qatar, mohamedizham@qu.edu.qa (MI).
⁵ Department of Cardiothoracic Surgery Heart Hospital, Hamad Medical Corporation, Doha, Qatar, abdulalkh@hamad.qa (AA), a_s_omar@yahoo.com (AO).
⁶ Department of Critical Care Medicine, Beni Suef University, Egypt (AO).

PMID: 38381697
DOI: 10.1097/HPC.0000000000000352

Abstract

Background: Cardiac arrest remains a critical condition with high mortality and catastrophic neurological impact. Extracorporeal cardiopulmonary resuscitation (ECPR) has been introduced as an adjunct in cardiopulmonary resuscitation modalities. However, survival with good neurological outcomes remains a major concern. This study aims to explore our early experience with ECPR and identify the factors associated with survival in patients presenting with refractory cardiac arrest.

Methods: A retrospective cohort study analyzing six-year data from a tertiary center, the country reference for ECPR.

Setting: A national center of ECPR.

Participants: Adult patients who experienced witnessed refractory cardiopulmonary arrest and were supported by ECPR.

Interventions: ECPR for eligible patients as per local service protocol.

Results: Data from 87 patients were analyzed; of this cohort, 62/87 patients presented with in-hospital cardiac arrest (IHCA), and 25/87 presented with out-of-hospital cardiac arrest (OHCA). Overall survival to decannulation and hospital discharge rates were 26.4% and 25.3%, respectively. Among survivors (n=22), 19 presented with IHCA (30.6%), whilst only 3 survivors presented with OHCA (12%). A total of 15/87 (17%) patients were alive at 6-month follow-up. All survivors had good neurological function assessed as Cerebral Performance Category 1 or 2. Multivariate logistic regression to predict survival to hospital discharge showed that IHCA was the only independent predictor (Odds Ratio 5.8, p =0.042), however, this positive association disappeared after adjusting for the first left ventricular ejection fraction after resuscitation.

Conclusion: In this study, the use of ECPR for IHCA was associated with a higher survival to discharge compared to OHCA. This study demonstrated a comparable survival rate to other established centers, particularly for IHCA. Neurological outcomes were comparable in both IHCA and OHCA survivors. However, large multicenter studies are warranted for better under-standing and improving the outcomes.