Aims: Retrospective studies have suggested improved survival outcomes with the use of Extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest (ECPR). We sought to prospectively assess outcomes in refractory cardiac arrest treated with ECPR.
Methods: The 2CHEER trial (mechanical CPR, Hypothermia, ECMO and Early Reperfusion) is a multi-centre, prospective cohort study conducted at Royal Prince Alfred and St Vincent’s Hospitals, Sydney, NSW with the NSW Ambulance service. Patients aged 12–70 years with refractory cardiac arrest were enrolled into the 2CHEER treatment bundle.
Results: From 2016 to 2018, 25 patients were eligible for the 2CHEER protocol (13 (52%) OHCA, 12 (48%) IHCA; 17 (68%) males. Median age was 57 (IQR 39–65) years and all patients received bystander CPR. VT/VF was initial rhythm in 17 (68%) of patients. ECMO flow was established in all patients; median time from collapse until initiation of ECMO 57 (IQR 38–73) min. Percutaneous coronary intervention was performed in 18 (72%) patients. Median duration of ECMO support was 52 (IQR 24 –108) hours. Survival to hospital discharge was 64% (7) for IHCA and (36% (4) for OHCA. Survival with favourable neurological outcome (CPC 1 or 2) occurred in all survivors; (11/25) (44%) of total patients. Time to ECMO flow was significantly associated with survival p < 0.001. Initial rhythm and percutaneous intervention were not.
Conclusion: Treatment of refractory cardiac arrest with ECMO is feasible and associated with very good neurologically intact survival.
