Authors: Siao FY et al., Resuscitation 2015 Jul 92:70
A small Taiwanese study showed significant improvement in long-term neurological function with this intensive intervention.
Survival after cardiac arrest remains low, even in patients with shockable rhythms. Extracorporeal membrane oxygenation (ECMO) may improve tissue perfusion during resuscitation, and case reports have described its use in emergency department (ED) patients in cardiac arrest. In a retrospective, observational study at a single Taiwanese ED, investigators compared outcomes in 20 patients with ventricular fibrillation who received ECMO and 40 who received conventional cardiopulmonary resuscitation (CPR).
Patients who received ECMO had longer resuscitation times (70 vs. 34 minutes), had more defibrillation attempts (9.7 vs. 6.5), and received more epinephrine doses (11.2 vs. 8.3 mg). The ECMO group also had higher likelihood of return of spontaneous circulation (“spontaneous beating” in ECMO patients; 95% vs. 48%) and survival to discharge with good neurological function (40% vs. 8%) Patients discharged with good neurological function maintained good neurological function at 1 year after discharge.
This study shows the enormous resources required to improve outcomes after cardiac arrest as well as the potential benefit of this approach. Because selection bias could have affected which patients received ECMO, these results support a prospective randomized trial rather than a change in practice.