Survival and neurological outcome with extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest caused by massive pulmonary embolism: A two center observational study

Loes Mandigers; Erik Scholten; Wim J R Rietdijk; Corstiaan A den Uil; Robert J van Thiel; Sander Rigter; Bram G A D H Heijnen; Diederik Gommers; Dinis Dos Reis Miranda

doi:10.1016/j.resuscitation.2018.12.008

Survival and neurological outcome with extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest caused by massive pulmonary embolism: A two center observational study

Resuscitation. 2019 Mar:136:8-13. doi: 10.1016/j.resuscitation.2018.12.008. Epub 2018 Dec 17.

Authors

Loes Mandigers¹, Erik Scholten², Wim J R Rietdijk³, Corstiaan A den Uil⁴, Robert J van Thiel³, Sander Rigter², Bram G A D H Heijnen², Diederik Gommers³, Dinis Dos Reis Miranda³

Affiliations

¹ Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: l.mandigers@erasmumc.nl.
² Department of Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands.
³ Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

PMID: 30572065
DOI: 10.1016/j.resuscitation.2018.12.008

Abstract

Background: Cardiac arrest (CA) due to pulmonary embolism (PE) is associated with low survival rates and poor neurological outcomes. We examined whether Extracorporeal Cardiopulmonary Resuscitation (ECPR) improves the outcomes of patients who suffer from CA due to massive PE.

Methods: We retrospectively included 39 CA patients with proven or strongly suspected PE in two hospitals in the Netherlands, in a 'before/after'-design. 20 of these patients were treated with Conventional Cardiopulmonary Resuscitation (CCPR) and 19 patients with ECPR.

Results: The main outcomes of this study were ICU survival and favourable neurological outcome, defined as Cerebral Performance Category (CPC) score 1-2. The ICU survival rate in CCPR patients was 5% compared to 26% in ECPR patients (p<0.01). Survival with favourable neurological outcome was present in 0/20 (0%) CCPR patients compared to 4/19 (21%) of the ECPR patients (p<0.05).

Conclusion: ECPR seems a promising treatment for cardiac arrest patients due to (suspected) massive pulmonary embolism compared to conventional CPR, though outcomes remain poor.

Publication types

Multicenter Study
Observational Study

MeSH terms

Adult
Cardiopulmonary Resuscitation / mortality*
Controlled Before-After Studies
Extracorporeal Membrane Oxygenation / mortality*
Female
Humans
Intensive Care Units / statistics & numerical data
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / etiology
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Pulmonary Embolism / complications
Pulmonary Embolism / diagnosis
Time-to-Treatment