• Viviane Zotzmann, Jonathan Rilinger, Corinna Nadine Lang, Daniel Duerschmied, Christoph Benk, Christoph Bode, Tobias Wengenmayer, and Dawid L Staudacher.
• Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: viviane.zotzmann@universitaets-herzzentrum.de.
• Resuscitation. 2020 Jan 1; 146: 149-154.

IntroductionInitiation of venoarterial extracorporeal membrane oxygenation (ECMO) under ongoing cardiopulmonary resuscitation (eCPR) in patients with refractory cardiac arrest may improve otherwise deleterious outcome. In general, the duration of mechanical resuscitation from collapse to ECMO ranges from 40 to 70 min. CPR-related injuries are reported frequently in non-eCPR patients. We wanted to quantify CPR-related injuries in eCPR patients.MethodsAll eCPR patients cannulated at a tertiary referral medical center between October 2010 and October 2017 were included in a retrospective registry study. A full-body CT scan was performed within the first 24 h after eCPR.ResultsA total of 103 patients (mean age 58.8 ± 16.7 years, CPR duration 61.7 ± 31.9 min, and hospital survival 13.6 %) underwent eCPR and immediate full-body computed tomography (CT). Full-body CT detected the cause for collapse in 16.5% of patients. Average number of pathologies detected per CT scan was 6.5 ± 3.3 findings per patient, of which 2.6 ± 1.5 findings were retrospectively considered of clinical relevance for subsequent treatment. Most frequent findings were multiple rib or sternal fractures (65.5%), pneumo- or hemothorax (32.3%) and pulmonary infiltrates (91.3%). Intracranial bleedings and cerebral edema were frequent (10.7% and 26.2%). A total of 20 patients (19.4%) had findings in whole-body CT that were considered to be so severe that further treatment was considered futile and therapy was subsequently discontinued. Most findings were associated with poor outcome with the exception of rib fractures, bleedings and abdominal trauma, which might have been caused by vigorous resuscitation efforts and were associated with favorable outcome.ConclusionA full-body CT scan performed after eCPR revealed substantial clinically significant findings. Therefore, it might be reasonable to routinely perform a full-body CT in all eCPR patients.Copyright © 2019 Elsevier B.V. All rights reserved.

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