Abstract
Introduction
Extracorporeal life support (ECLS) has shown promise in the management of cardiac
arrest. The purpose of this study was to examine temporal trends and predictors of
ECLS utilization and survival to discharge among inpatients with cardiac arrest in
the United States.
Methods
All patients admitted after out-of-hospital cardiac arrest (OHCA) and those who experienced
in-hospital cardiac arrest (IHCA) from 2005 to 2014 were identified in the National
Inpatient Sample. Patients carrying a pregnancy as well as those with do-not-resuscitate
orders or trauma-related diagnoses were excluded. Multivariable logistic regression
was used to identify predictors of ECLS utilization and survival to discharge.
Results
An estimated 1,624,827 patients were identified. During the study period, use of ECLS
increased from 77 to 564 per 100,000 arrests for OHCA, and 60 to 632 per 100,000 arrests
for IHCA. Survival among patients on ECLS for OHCA and IHCA increased from 34.2% to
54.2% and from 4.7% to 19.2%, respectively. Age, year of arrest, cardiac rhythm, and
the presence of a potentially reversible etiology including myocardial infarction
and pulmonary embolism, were predictive of ECLS utilization. Among patients placed
on ECLS, age, rhythm at arrest, and location of arrest were predictive of survival
to discharge.
Conclusions
Mortality after cardiac arrest for those on ECLS has substantially decreased. Younger
age, shockable rhythm, and out-of-hospital arrest location were predictive of survival
or utilization. As ECLS use increases, it is critical to define selection criteria
that maximize the benefits of ECLS.
Abbreviations:
NIS (National Inpatient Sample), IHCA (in-hospital cardiac arrest), OHCA (out-of-hospital cardiac arrest), ECLS (extracorporeal life support), CPR (cardiopulmonary resuscitation), VT (ventricular tachycardia), VF (ventricular fibrillation), PEA (pulseless electrical activity), MI (myocardial infarction), MCS (mechanical circulatory support), AOR (adjusted odds ratio), CI (confidence interval)Keywords
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Article info
Publication history
Published online: March 17, 2020
Accepted:
February 28,
2020
Received in revised form:
February 9,
2020
Received:
November 13,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
