ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome
Mustafa Emre Gürcü1, Şeyhmus Külahçıoğlu2, Pınar Karaca Baysal1, Serdar Fidan2, Cem Doğan2, Rezzan Deniz Acar2, Atakan Erkılınç1, Gökhan Alıcı2, Nihal Özdemir2, Kaan Kırali3
1Department of Anesthesiology and Reanimation, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
2Department of Cardiology, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
3Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2021.21238
Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients.

Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded.

Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%.

Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

Keywords : Acute coronary syndrome, conventional cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation, extracorporeal membrane oxygenation, ventricular fibrillation
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