Resuscitation Plus (Mar 2024)

Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: 10-year experience in a metropolitan cardiac arrest centre in Milan, Italy

  • Tommaso Scquizzato,
  • Maria Grazia Calabrò,
  • Annalisa Franco,
  • Evgeny Fominskiy,
  • Marina Pieri,
  • Pasquale Nardelli,
  • Silvia Delrio,
  • Savino Altizio,
  • Alessandro Ortalda,
  • Giulio Melisurgo,
  • Silvia Ajello,
  • Giovanni Landoni,
  • Alberto Zangrillo,
  • Anna Mara Scandroglio,
  • Martina Crivellari,
  • Monica De Luca,
  • Greta Fano,
  • Giovanna Frau,
  • Alessandro Oriani,
  • Chiara Gerli,
  • Marta Mucchetti,
  • Alessandro Belletti,
  • Gaia Barucco,
  • Ambra Licia Di Prima,
  • Margherita Licheri,
  • Sabrina Zarantonello,
  • Giancarlo Otello Turla,
  • Claudia Francescon

Journal volume & issue
Vol. 17
p. 100521

Abstract

Read online

Introduction: Growing evidence supports extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OHCA) patients, especially in experienced centres. We present characteristics, treatments, and outcomes of patients treated with ECPR in a high-volume cardiac arrest centre in the metropolitan area of Milan, Italy and determine prognostic factors. Methods: Refractory OHCA patients treated with ECPR between 2013 and 2022 at IRCCS San Raffaele Scientific Institute in Milan had survival and neurological outcome assessed at hospital discharge. Results: Out of 307 consecutive OHCA patients treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58–81] minutes), 17% survived and 9.4% had favourable neurological outcome. Survival and favourable neurological outcome increased to 51% (OR = 8.7; 95% CI, 4.3–18) and 28% (OR = 6.3; 95% CI, 2.8–14) when initial rhythm was shockable and low-flow (time between CPR initiation and ROSC or ECMO flow) ≤60 minutes and decreased to 9.5% and 6.3% when low-flow exceeded 60 minutes (72% of patients). At multivariable analysis, shockable rhythm (aOR for survival = 2.39; 95% CI, 1.04–5.48), shorter low-flow (aOR = 0.95; 95% CI, 0.94–0.97), intermittent ROSC (aOR = 2.5; 95% CI, 1.2–5.6), and signs of life (aOR = 3.7; 95% CI, 1.5–8.7) were associated with better outcomes. Survival reached 10% after treating 104 patients (p for trend <0.001). Conclusions: Patients with initial shockable rhythm, intermittent ROSC, signs of life, and low-flow ≤60 minutes had higher success of ECPR for refractory OHCA. Favourable outcomes were possible beyond 60 minutes of low-flow, especially with concomitant favourable prognostic factors. Outcomes improved as the case-volume increased, supporting treatment in high-volume cardiac arrest centres.

Keywords