Favorable Survival of In-Hospital Compared with Out-of-Hospital Refractory Cardiac Arrest Patients Treated with Extracorporeal Membrane Oxygenation: An Italian Tertiary Care Center Experience

Objective: Extracorporeal membrane oxygenation (ECMO) support has been suggested to improve survival in patients with refractory in- and out-of-hospital cardiac arrest (IHCA, OHCA). Aim of the present study was to report our experience on the use of ECMO in adult patients with refractory IHCA and OHCA. We have further examined outcome differences between IHCA and OHCA and factors accounting for such differences. Methods: Forty-two patients (31 males) with refractory cardiac arrest, 24 IHCA and 18 OHCA, were enrolled in this single centre, retrospective, observational study, from January 2006 to December 2010. Results: There was significant difference in the time of no-flow (duration of untreated cardiac arrest) between the OHCA and IHCA patients (p<0.001). The time of low flow (duration of CPR prior to ECMO) was also significantly longer in the OHCA group compared with the IHCA one (77 mins vs 55 mins, p<0.001). ECMO implantation was successful in 38 (90%) of the 42 patients. ECMO support was positioned: 3 times (8%) in the operating room, 6 (16%) in the cardiac surgery intensive care unit, 21 (55%) in the emergency department, 5 (13%) in the catheterization laboratory and 3 (8%) in general ward. A total of 14 IHCA (58%) and 3 OHCA (16%) patients were weaned from ECMO (p<0.05). 11 IHCA (46%) and 1 OHCA (5% p<0.05) were discharged from intensive care unit (ICU). Among IHCA patients, 10 were alive at 6 months, 9 of whom (38%) with good neurological outcome. Among OHCA patients weaned from ECMO, one was alive at six months with good neurological outcome (5%, p<0.05 vs IHCA). Conclusions: ECMO support should be considered as a resuscitation alternative in selected patients. More specifically, patients with witnessed IHCA have more benefits from ECMO treatment compared to those who experience an out-of-hospital cardiac arrest. Formula Author Disclosures: L. Avalli: None. G. Greco: None. F. Sangalli: None. L. Galbiati: None. M. Trabucchi: None. F. Formica: None. C. Costa: None. G. Ristagno: None. R. Fumagalli: None.