Prognostic Factor in Extracorporeal Cardiopulmonary Resuscitation for Refractory In- and Out-of-Hospital Cardiac Arrest.
The Journal of emergency medicine · 2025-05-16 · Observational study
Abstract
BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is used to improve the prognosis of patients with cardiac arrest (CA) refractory to conventional cardiopulmonary resuscitation (CCPR); however, ECPR carries several risks including futility and high cost. Although ECPR requires proper and rapid decision-making, the immediately available prognostic factors remain unclear. OBJECTIVES: This study evaluated the prognostic factors available during CCPR among patients with in-hospital CA (IHCA) and out-of-hospital CA (OHCA), respectively. METHODS: This single-center retrospective study included consecutive ECPR recipients at our institution from January 2013 to September 2024. Uni- and multivariate logistic analyses were performed to identify predictors of 30-day mortality. RESULTS: Of the 204 patients (age, 63 ± 14 years; male, 77%; OHCA, 45%; out-of-hours ECPR, 52%; initial shockable rhythm, 52%) included in this study, the overall 30-day survival rate was 24%. Patients with IHCA had a significantly better survival rate than those with OHCA (30% vs. 15%, p = 0.013). The optimal lactate cutoff values for discriminating outcomes were 9.2 mmol/L for IHCA and 14.3 mmol/L for OHCA. Among patients with IHCA, serum lactate levels, and initial shockable rhythm were significantly associated with 30-day mortality, whereas among patients with OHCA, serum lactate levels, out-of-hours ECPR, and bystander CPR were independent prognostic factors. CONCLUSION: Determining serum lactate levels before ECPR is potentially useful for prompt and accurate decision-making among patients with IHCA or OHCA. However, greater discretion may be required for out-of-hours ECPR in patients with OHCA. Larger studies validating these observations are needed to identify optimal candidates for ECPR.