J Cardiovasc Interv.  2022 Jan;1(1):40-48. 10.54912/jci.2021.0001.

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest According to Cannulation Sites: Cath Lab vs Non-Cath Lab

• Lim Y
• Kim MC
• Jeong IS
• Jung Y
• Ahn JH
• Lee SH
• Hyun DY
• Cho KH
• Sim DS
• Hong YJ
• Kim J
• Ahn Y
• Jeong MH

• KMID: 2561239
• DOI: http://doi.org/10.54912/jci.2021.0001

Abstract

Background
In extracorporeal cardiopulmonary resuscitation (ECPR), quick restoration of spontaneous circulation by safe and accurate cannulation is important. Performance and outcomes of ECPR for in-hospital cardiac arrest (IHCA) might be affected by sites of ECPR. We analyzed outcomes of ECPR for IHCA performed in different sites—cath lab vs non-cath.
Methods
Outcomes of ECPR for 40 patients who experienced IHCA in a tertiary academic medical center were retrospectively analyzed according to cannulation sites. A primary outcome was low flow time. Secondary outcomes included cannulation time, rate of cannulation related complication(s), initial lactate measured after extracorporeal membrane oxygenation pump on, 8-hour lactate level and its clearance (%), death on the day, and survival to discharge.
Results
Cannulation for 23 patients was performed in non-cath lab sites including an intensive care unit or an emergency room. ECPR for 17 remaining patients were performed in a cath lab. Low flow time (25.0 minutes vs 34 minutes, P = 0.028) and cannulation time (10 minutes vs 16 minutes, P = 0.041) in the cath lab cannulation group. The rate of cannulation related complication was not statistically different (39.1% in vs 23.5%, P = 0.484). Aberrant vein or artery cannulation occurred only in the non-cath lab cannulation group (4 vs 0). Initial lactate was higher in the non-cath lab cannulation group (14.4 mmol/L vs 9.2 mmol/L, P < 0.01) with comparable 8-hour lactate level (6.1 mmol/L vs 4.6 mmol/L, P = 0.118) and 8-hour lactate clearance (54.8% vs 52.7%, P = 1). Death on the day of ECPR (34.8% vs 11.8%, P = 0.196) and survival to discharge (34.8% vs 47.1%, P = 0.648) were not statistically different.
Conclusions
ECPR for IHCA in a cath lab reduced low flow and cannulation time but did not improve clinical outcomes compared to ECPR performed in non-cath lab sites.

Keyword

In-hospital cardiac arrest; Extracorporeal membrane oxygenation; Extracorporeal cardiopulmonary resuscitation; Cath lab; Cannulation site