The impact of on-site cardiac rhythm on mortality in patients supported with extracorporeal cardiopulmonary resuscitation: A retrospective cohort study

Gabor Erdoes; Daniel Weber; Andreas Bloch; Paul Philipp Heinisch; Markus Huber; Jan Oliver Friess

doi:10.1111/aor.14239

The impact of on-site cardiac rhythm on mortality in patients supported with extracorporeal cardiopulmonary resuscitation: A retrospective cohort study

Artif Organs. 2022 Aug;46(8):1649-1658. doi: 10.1111/aor.14239. Epub 2022 Apr 5.

Authors

Gabor Erdoes¹, Daniel Weber², Andreas Bloch^{3

4}, Paul Philipp Heinisch⁵, Markus Huber¹, Jan Oliver Friess¹

Affiliations

¹ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Anaesthesiology and Intensive Care Medicine, Spital Limmattal, Schlieren, Switzerland.
³ Department of Intensive Care Medicine, Kantonsspital Lucerne, Lucerne, Switzerland.
⁴ Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 35318673
DOI: 10.1111/aor.14239

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used in patients with out-of-hospital or in-hospital cardiac arrest in whom conventional cardiopulmonary resuscitation remains unsuccessful. The aim of this study was to analyze the impact of initial cardiac rhythm-detected on-site of the cardiac arrest-on mortality.

Methods: We performed a retrospective cohort study of patients who received ECPR in our tertiary care cardiac arrest center. Patients were divided into three groups depending on their cardiac rhythm: shockable rhythm, pulseless electrical activity, and asystole. The primary endpoint was mortality within the first 7 days after ECPR deployment. Secondary endpoints were mortality within 28 days and the impact of pre-ECPR potassium, serum lactate, pH, and pCO₂ on mortality. The association of the initial cardiac rhythm and the location of arrhythmia detection (patient monitored in hospital [category: monitored], not monitored but hospitalized [in-hospital], not monitored, not hospitalized [out-of hospital]) with the primary and secondary outcome was examined by means of univariable and multivariable logistic regression.

Results: Sixty-five patients could be included in the final analysis. Thirty-two patients (49.2%, 95%CI 36.6%-61.9%) died within the first 7 days. In terms of 7-day-mortality patients differed in the initial cardiac rhythm (p = 0.040) and with respect to the location of arrhythmia detection (p = 0.002). Shockable cardiac rhythm (crude OR 0.21; 95%CI 0.03-0.98) and pulseless electrical activity (0.13; 0.02-0.61) as the initial rhythm on-site showed better odds for survival compared to asystole. However, this association did neither persist in adjusted analysis nor pairwise comparison.

Discussion: The study could not demonstrate a better outcome with shockable rhythm after ECPR. More homogeneous and adequately powered cohorts are needed to better understand the impact of cardiac rhythm on patient outcomes after ECPR.

Keywords: cardiac arrest; cardiac rhythm; extracorporeal cardiopulmonary resuscitation; mortality.

MeSH terms

Arrhythmias, Cardiac / diagnosis
Arrhythmias, Cardiac / therapy
Cardiopulmonary Resuscitation* / methods
Heart Arrest* / therapy
Humans
Logistic Models
Retrospective Studies