Extracorporeal Cardiopulmonary Resuscitation: Outcomes and Complications at a Quaternary Referral Center

Abstract

Objective: At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal cardiopulmonary resuscitation (eCPR), a database of all adult patients who underwent eCPR with venoarterial extracorporeal membrane oxygenation (ECMO) over a 10-year period was reviewed. Seventy-one eCPR patients were analyzed to compare outcomes and complication rates. The authors hypothesized that evidence of end-organ injury, such as the need for continuous renal replacement therapy, in their institution's eCPR population would be associated with increased in-hospital mortality.

Design: Retrospective chart review of prospectively collected data at a quaternary care center.

Setting: Single quaternary academic referral center for ECMO.

Participants: The study comprised adult patients who underwent venoarterial ECMO for eCPR from 2009-2019 and for whom demographic data, survival data, and complication rates were available.

Interventions: None-this was a retrospective chart review.

Measurements and main results: eCPR survival was 53.5% (38 of 71), and hospital survival was 33.8% (24 of 71). The most common complications were hemorrhage (26 of 67), renal failure (19 of 67), and neurologic injury (14 of 67). Of 19 patients requiring renal replacement therapy, only 1 survived to hospital discharge (5.3%) versus 23 of 48 patients without renal failure (47.9%) surviving to discharge (p = 0.001).

Conclusions: In this cohort of 71 patients who underwent eCPR, outcomes were promising; however, complication rates were high, and renal failure in particular demonstrated an extremely high mortality. These are single-institution results that should be followed up with larger multicenter cohorts of eCPR patients.

Keywords: ECLS; ECMO; eCPR; echocardiography; extracorporeal cardiopulmonary resuscitation; extracorporeal life support; extracorporeal membrane oxygenation; outcomes.