Korean Circ J.  2021 Nov;51(11):908-918. 10.4070/kcj.2021.0167.

Association between a Multidisciplinary Team Approach and Clinical Outcomes in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation in the Emergency Department

• Lee JH
• Ko RE
• Park TK
• Cho YH
• Suh GY
• Yang JH

• KMID: 2522108
• DOI: http://doi.org/10.4070/kcj.2021.0167

Abstract

Background and Objectives
Despite recent improvements in advanced life support, the overall survival rate after cardiac arrest remains low. We aimed to examine the association of a multidisciplinary team approach with clinical outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) in the emergency department (ED).
Methods
This retrospective, single-center, observational study included 125 patients who underwent ECPR in the ED between May 2004–December 2018. In January 2014, our institution implemented a multidisciplinary extracorporeal membrane oxygenation (ECMO) team. Eligible patients were classified into pre-ECMO-team (n=65) and post-ECMO-team (n=60) groups. The primary outcome was in-hospital mortality.
Results
In-hospital mortality (72.3% vs. 58.3%, p=0.102) and poor neurological outcomes (78.5% vs. 68.3%, p=0.283) did not differ significantly between the pre- and post-ECMOteam groups. However, among the 60 patients who experienced in-hospital cardiac arrest,in-hospital mortality (75.8% vs. 40.7%, p=0.006) and poor neurological outcomes (78.8% vs. 48.1%, p=0.015) significantly decreased after the multidisciplinary team formation. Multivariable logistic regression analysis showed that the multidisciplinary team approach (adjusted odds ratio, 0.20; 95% confidence interval, 0.07–0.61; p=0.005) was an independent prognostic factor for in-hospital mortality in in-hospital cardiac arrest patients.
Conclusions
A multidisciplinary team approach was associated with improved clinical outcomes in in-hospital cardiac arrest patients undergoing ECPR in the ED. These findings may help in improving the selection criteria for ECPR in the ED. Further studies to overcome the study limitations may help improving the outcomes of out-of-hospital cardiac arrest patients.

Keyword

Cardiac arrest; Extracorporeal life support; Resuscitation; Emergency medicine

Figure

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  Figure 1 Study flow chart.ECMO = extracorporeal membrane oxygenation; ECPR = extracorporeal cardiopulmonary resuscitation.

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  Figure 2 In-hospital mortality and poor neurological outcomes in the pre- and post-ECMO-team groups. A multidisciplinary team approach was associated with improved clinical outcomes in (A) IHCA patients, but not in (B) OHCA patients.ECMO = extracorporeal membrane oxygenation; IHCA = in-hospital cardiac arrest; OHCA = out-of-hospital cardiac arrest.

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