Extracorporeal life support (ELS) combined with conventional cardiopulmonary resuscitation (CPR) roughly doubles survival in adult hospital patients compared with CPR alone. These are the conclusions of authors of an Article published early Online and in an upcoming edition of The Lancet.
Sudden cardiac arrest still has a low survival rate despite introduction of CPR, with the rate remaining unchanged since 1993. Investigations have shown that survival rate declines rapidly when CPR exceeds 10 minutes duration, and even more rapidly if it exceeds 30 minutes. ELS has shown encouraging outcomes in cardiac arrest patients. ELS enhances coronary blood-flow and keeps heart tissue alive, and thus can reduce the time to return of spontaneous circulation. ELS also supplies blood to multiple organs, prevents organ dysfunctions, and increases the likelihood of late survival. And while patients are receiving ELS, the underlying cause of their cardiac arrest could be being diagnosed, and vital life-saving drug or other treatments started.
ELS works via insertion of a catheter into the femoral artery/vein (leg). The patient receives continuous chest compression until the start of ELS, at which point blood travels through the catheter via a pump, heat-exchanger, and oxygenator before returning to the body oxygenated. The temperature regulator means that hypothermia can be induced if required to protect the patient from brain injury.
Dr Yih- Sharng Chen and Dr Jou-Wei Lin, National Taiwan University Hospital, Taipei, Taiwan, and colleagues aimed to assess whether ELS combined with CPR was better than CPR alone for patients with in-hospital cardiac arrest of cardiac origin. In the three-year study, patients aged 18-75 years who had undergone CPR for more than 10 minutes were enrolled into the conventional CPR group (113 patients) or ELS and CPR (59 patients). Patients who received ELS had better survival rate to discharge, better 30-day survival and better 1-year survival than patients in the conventional CPR group. For each of these three survival end-points, patients receiving ELS were around half as likely to die as those receiving CPR alone.
The authors conclude: "Extracorporeal CPR had a short-term and long-term survival benefit over conventional CPR in patients with in-hospital cardiac arrest of cardiac origin."
In an accompanying Comment, Dr Sung-Woo Lee and Dr Yun-Sik Hong, Korea University Ansan Hospital Emergency Department, Seoul, South Korea, say: "Future studies should use subgroups of patients with cardiac arrest of cardiac origin and no response to the conventional CPR for more than 10 minutes who are likely to benefit from extracorporeal life-support. Moreover, if progress is satisfactory, we expect that patients getting conventional CPR will benefit from extracorporeal life-support in the near future."
Dr Yih-Sharng Chen and Dr Jou-Wei Lin, National Taiwan University Hospital, Taipei, Taiwan T) + 886-928-827-542 E) yschen1234@gmail.com
Dr Sung-Woo Lee and Dr Yun-Sik Hong, Korea University Ansan Hospital Emergency Department, Seoul, South Korea T) +81-31-412-5380 E) kuedlee@korea.ac.kr
http://www.eurekalert.org/jrnls/lance/pdfs/lifesupportart&comfinal.pdf
Journal
The Lancet