The influence of preexisting coronary artery disease on long-term follow up and neurological outcome in patients receiving out of hospital extracorporeal membrane oxygenation

Background

Pre-hospital extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest is costly and resource-intensive. Low survival rates raise questions concerning efficacy of ECPR. We aimed to analyze survival and neurological outcome of these patients and the influence of underlying coronary artery disease as well as shockable heart rhythm leading to resuscitation.

Methods

Retrospective analysis of our ECMO database revealed 94 patients receiving ECPR for out-of-hospital cardiac arrest from September 2009 to May 2023. After exclusion of patients with pulmonary embolism, drowning or intoxication as confounders, 58 patients remained. Patients were divided into 2 groups depending on underlying coronary artery disease and initial heart rhythm. Primary outcome was survival to discharge and long-term survival, secondary outcome was neurological capacity analyzed with the cerebral performance category score (CPC).

Results

26 patients (44.8 %) survived to discharge; 6 patients died during a median follow-up time of 1057.5 days. There was no significant difference concerning survival to discharge between the groups. Numerically, more patients with shockable rhythm and without coronary artery disease survived. Kaplan-Meier analysis revealed a survival benefit for patients with shockable rhythm without coronary artery disease (p < 0.007). 92.3 % of survivors had a CPC-Score of 1. CPC Score did not differ between the groups.

Conclusion

Though mortality in ECPR patients remains high with 55.2 %, long-term and neurological outcome with a CPC score of 1 is very good, especially of those with shockable rhythm and without coronary artery disease. Old age and duration of cardiopulmonary resuscitation pre-ECMO impair neurological outcome. Thus, on-site ECMO cannulation should be endorsed.