Extracorporeal Life Support for Refractory Cardiac Arrest in ED Patients

Authors: Johnson NJ et al., Resuscitation 2014 Sep 6;

A small registry study adds to the growing body of literature showing feasibility of ECLS.

Extracorporeal life support (ECLS) has been used as a rescue strategy for patients who do not respond to standard resuscitation. Investigators report outcomes for 26 adults who received ECLS for out-of-hospital, emergency department, or in-hospital cardiac arrest at two urban academic medical centers over 7 years. Patients were enrolled at the discretion of the treating physician in consultation with a cardiothoracic surgeon, according to a consensus-based protocol.

Mean time from arrest to initiation of ECLS was 77 minutes (range, 12–180 minutes). ECLS was initiated during cardiopulmonary resuscitation in most patients (77%). Eighteen patients (69%) had complications, including lower extremity ischemia, stroke, gastrointestinal hemorrhage, bleeding at the cannulation site, and hepatic and renal failure. Four patients (15%) survived to hospital discharge (three were neurologically intact).

Comment
When patients do not respond to conventional measures, continuation of resuscitation is generally futile. ECLS is resource intensive, expensive, and has a high rate of complications. Until we have a randomized trial verifying its value, ECLS should not be considered a “go-to” therapy for refractory cardiac arrest.