• Andrea L Axtell, Masaki Funamoto, Alex G Legassey, Philicia Moonsamy, Kenneth Shelton, David A D'Alessandro, Mauricio A Villavicencio, Thoralf M Sundt, and Gaston A Cudemus.
• Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA.
• J. Cardiothorac. Vasc. Anesth. 2020 Feb 1; 34 (2): 356-362.

ObjectiveExtracorporeal membrane oxygenation (ECMO) as a rescue strategy during cardiopulmonary resuscitation (ECPR) is increasingly being used for nonresponders to conventional cardiopulmonary resuscitation. To identify patients most likely to benefit from ECPR, the authors investigated predictors of hospital discharge with good neurologic function.DesignRetrospective cohort analysis.SettingSingle institution academic medical center.ParticipantsPatients who underwent ECPR.InterventionsVenoarterial ECMO initiation for witnessed refractory cardiac arrest from 2009-2019.Measurements And Main ResultsBaseline characteristics and post-ECMO outcomes were compared between patients who had good versus poor neurologic function at discharge. Good neurologic function was defined as a cerebral performance category 1 to 2, whereas poor neurologic function was defined as a cerebral performance category 3 to 5. Of 54 patients, 13 (24%) were discharged with good neurologic function and 41 (76%) had poor neurologic function (n = 38 in-hospital deaths; n = 3 discharged with severe disability.) Survivors with good neurologic function were younger (41 v 61 y; p = 0.03), more likely to arrest because of pulmonary embolism (46% v 10%; p = 0.01), and more likely to receive concurrent Impella (Abiomed, Danvers, MA) placement while on ECMO (38% v 12%; p = 0.03.) Young age was the most important predictor of good neurologic function (odds ratio 0.92 [0.87-0.97]; p = 0.004), with a threshold for improved survival around 60 years. For all patients, survival to discharge was 30%; however, among survivors with good neurologic function, 5-year survival was 100%.ConclusionsECPR is associated with high rates of neurologic morbidity and mortality. However, in select patients, it may be an acceptable option with favorable long-term survival. Additional studies are indicated to further define the appropriate selection criteria for ECPR implementation.Published by Elsevier Inc.

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