• Mark Dennis, Hergen Buscher, David Gattas, Brian Burns, Karel Habig, Paul Bannon, Sanjay Patel, Heidi Buhr, Claire Reynolds, Sean Scott, Priya Nair, Jon Hayman, Emily Granger, Ryan Lovett, Paul Forrest, Jennifer Coles, David A Lowe, and Sydney ECMO Research Interest Group.
• Sydney Medical School, University of Sydney, Sydney, NSW, Australia. mark.dennis@sydney.edu.au.
• Crit Care Resusc. 2020 Mar 1; 22 (1): 263426-34.

BackgroundPatients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial).MethodsProspective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected).ResultsTwenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035).ConclusionECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.

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