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Extracorporeal Cardiopulmonary Resuscitation (ECPR) Survival: A Quaternary Center Analysis
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  • Lucas Marinacci,
  • Nino Mihatov,
  • David D'Alessandro,
  • Mauricio Villavicencio,
  • Nathali Roy,
  • Yuval Raz,
  • Sunu Thomas
Lucas Marinacci
Massachusetts General Hospital

Corresponding Author:[email protected]

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Nino Mihatov
NewYork-Presbyterian/Columbia University Medical Center
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David D'Alessandro
Massachusetts General Hospital
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Mauricio Villavicencio
Massachusetts General Hospital
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Nathali Roy
Boston Children's Hospital
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Yuval Raz
Massachusetts General Hospital
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Sunu Thomas
Massachusetts General Hospital
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Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue strategy for non-responders to conventional CPR (CCPR) in cardiac arrest. Definitive guidelines for ECPR deployment do not exist. Prior studies suggest that arrest rhythm and cardiac origin of arrest may be variables used to assess candidacy for ECPR. Aim: To describe a single center experience with ECPR and to assess associations between survival and physician-adjudicated origin of arrest and arrest rhythm. Methods: A retrospective review of all patients who underwent ECPR at a quaternary care center over a 7-year period was performed. Demographic and clinical characteristics were extracted from the medical record and used to adjudicate origin of cardiac arrest, etiology, rhythm, survival, and outcomes. Univariate analysis was performed to determine association of patient and arrest characteristics with survival. Results: Between 2010 and 2017, 47 cardiac arrest patients were initiated on extracorporeal membrane oxygenation (ECMO) at the time of active CPR. ECPR patient survival to hospital discharge was 25.5% (n=12). Twenty-six patients died on ECMO (55.3%) while 9 patients (19.1%) survived decannulation but died prior to discharge. Neither physician-adjudicated arrest rhythm nor underlying origin were significantly associated with survival to discharge, either alone or in combination. Younger age was significantly associated with survival. Nearly all survivors experienced myocardial recovery and left the hospital with a good neurological status. Conclusions: Arrest rhythm and etiology may be insufficient predictors of survival in ECPR utilization. Further multi-institutional studies are needed to determine evidenced based criteria for ECPR deployment.
10 Feb 2021Submitted to Journal of Cardiac Surgery
11 Feb 2021Submission Checks Completed
11 Feb 2021Assigned to Editor
11 Feb 2021Reviewer(s) Assigned
14 Feb 2021Review(s) Completed, Editorial Evaluation Pending
15 Feb 2021Editorial Decision: Revise Major
08 Mar 20211st Revision Received
09 Mar 2021Submission Checks Completed
09 Mar 2021Assigned to Editor
09 Mar 2021Reviewer(s) Assigned
22 Mar 2021Review(s) Completed, Editorial Evaluation Pending
22 Mar 2021Editorial Decision: Accept
Jul 2021Published in Journal of Cardiac Surgery volume 36 issue 7 on pages 2300-2307. 10.1111/jocs.15550