Perioperative Extracorporeal Cardiopulmonary Resuscitation in Adults: A Single-center Retrospective Review and Analysis.

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (CPR) for refractory in-hospital cardiac arrest has been associated with improved survival compared with conventional CPR. Perioperative patients represent a unique cohort of the inpatient population. This study aims to describe and analyze the characteristics and outcomes of patients who received extracorporeal CPR for perioperative cardiac arrest.

Methods: A single-center retrospective review of perioperative extracorporeal CPR in adults from January 2015 to August 2022 was performed. Patient demographics, cardiac arrest variables, and outcome data were obtained and analyzed. The primary study outcome was survival with favorable neurologic outcome.

Results: A total of 33 patients received extracorporeal CPR for perioperative cardiac arrest. Of the 33 patients, 24 (73%) had a cardiac arrest in the cardiac catheterization laboratory, while 9 (27%) had a cardiac arrest in the operating room or interventional radiology suite. Survival to discharge was 57.6%, of whom 17 (89.5%) had neurologically favorable outcomes with cerebral performance category scores of 1 or 2 at discharge. The mean total CPR time was significantly lower in the survivor group than in the nonsurvivor group (16.5 vs . 25.0 min; P < 0.05). Survivors had significantly lower lactate levels (73 mg/dl vs . 115 mg/dl; P = 0.005) and higher pH levels (7.17 vs. 7.03; P = 0.005) compared with nonsurvivors.

Conclusions: The use of extracorporeal CPR for adults with perioperative cardiac arrest can be associated with excellent survival with neurologically favorable outcomes in carefully selected patients. Longer CPR time, higher lactate levels, and lower pH were associated with increased mortality. Given the small sample size, no other prognostic factors were identified, although certain trends were detected between survival groups.