Developing a risk prediction model for survival to discharge in cardiac arrest patients who undergo extracorporeal membrane oxygenation
Introduction
Cardiopulmonary resuscitation (CPR) has traditionally been the treatment of choice for cardiopulmonary collapse and it has been developed and modified to achieve better survival. Unfortunately, previous studies revealed a low survival to discharge rate that ranged from 7 to 26% [1], [2], [3], [4], which declines rapidly if the duration of CPR exceeds 10 min [5], [6], [7]. Recently, extracorporeal cardiopulmonary resuscitation (ECPR) with a portable cardiopulmonary bypass system has been increasingly utilized to supply oxygenated blood in the absence of spontaneous cardiac pumping [8], [9]. Several observation studies have shown an improved survival rate compared to conventional CPR in patients with in-hospital cardiac arrest [10], [11]. However, to date, there have been no guidelines for the application of ECMO in the setting of CPR and the prognostic factors under ECPR have not been fully established in patients with in-hospital cardiac arrest. Therefore, we investigated the predictive risk factors for in-hospital death and developed a risk prediction model to better inform physicians of suitable candidates and their expected survival rate in cardiac arrest patients undergoing ECPR.
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Study population
This was a retrospective, single-center, observational study of consecutive adult patients with in-hospital cardiac arrest who had ECPR at Samsung Medical Center between January 2004 and December 2012. This study received the Institutional Review Board approval and informed consent was waived. Clinical, laboratory, and outcome data were collected by a trained study coordinator using a standardized case report form. Additional information was documented by reviewing hospital records and
Baseline and procedural characteristics
Among 152 adult cardiac arrest patients who underwent ECPR, successful ECMO weaning was achieved in 67 patients (44.1%) and survival to discharge was identified in 48 patients (31.6%). The demographic patient data are shown in Table 1. There were no significant differences between non-survival and survival groups except for the diabetes. The initial arrest and procedural findings are shown in Table 2. A cardiogenic origin was the most common cause of cardiopulmonary resuscitation (n = 125, 82.2%)
Discussion
In our study, we investigated the risk factors predictive of survival and developed a new prognostic scoring system to predict survival to discharge for in-hospital cardiac arrest adult patients who underwent ECPR using a single-center registry for nine years. Old age, arrest rhythm of asystole, delayed ECMO pump-on, low initial pulse pressure, and poor initial SOFA score were independent predictors of in-hospital death. The ECPR score, which was developed using β coefficients of five
Funding source
None.
Conflict of interest
The authors declare no conflicts of interest. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
Acknowledgments
We appreciate the excellent statistical support of Seonwoo Kim, PhD, and Joonghyun Ahn, MS at the Samsung Biomedical Research Institute.
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