Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience

BackgroundCardiopulmonary resuscitation displays low survival rate after out-of-hospital cardiac arrest (OHCA). Extracorporeal life support (ECLS) could be suggested as a rescue therapeutic option in refractory OHCA. The aim of this report is to analyze our experience of ECLS implantation for refractory OHCA.MethodsWe performed a retrospective observational analysis of our prospectively collected database. Patients were divided into a shockable rhythm (SH-R) and a non-shockable rhythm (NSH-R) group according to cardiac rhythm at ECLS implantation. The primary endpoint was survival to hospital discharge with good neurological recovery.ResultsFrom January 2010 to December 2014 we used ECLS in 68 patients (SH-R, n = 19, 27.9% vs. NSH-R, n = 49, 72.1%) for refractory OHCA. The clinical profile before ECLS implantation was comparable between the groups. Eight (11.7%) patients were successfully weaned from ECLS (SH-R = 31.5% vs. NSH-R = 4.0%, p = 0.01) after a mean period of support of 2.1 days (SH-R = 4.1 days vs. NSH-R = 1.4 days, p = 0.01). Six (8.8%) patients survived to discharge (SH-R = 31.5% vs. NSH-R = 0%, p = 0.00). In the SH-R group 50% of the survivors were discharged without neurological complications.ConclusionsECLS for refractory OHCA should be limited in consideration of its poor, especially neurological, outcome. Non-shockable rhythms could be considered as a formal contraindication allowing a concentration of our efforts on the shockable rhythms, where the chances of success are substantial.