Cardiac Arrest Patient Survival Rates Doubled By Using Extracorporeal Life Support

When
combined with the conventional cardiopulmonary resuscitation (CPR),
extracorporeal life support (ELS) can double the survival of adult
hospital patients in comparison with CPR alone. These results were
released on July 7, 2008 in The Lancet.

Myocardial
infarction, or heart attack, occurs when blood flow to the beating
heart is restricted. This is related but not equivalent to
sudden
cardiac arrest, which is a sudden halt in all blood flow because the
heart does not contract properly. Even when CPR is introduced, sudden
cardiac arrest has a low survival rate which has not changed
significantly since 1993. Previous studies investigating the
relationship between CPR and survival rates have shown that, once CPR
has been performed for ten minutes, survival rates do drop
significantly, and even more if this exceeds 30 minutes.

Another
method of support for cardiac arrest patients is extracorporeal life
support, which acts via insertion of a catheter into the femoral vein
and artery in the leg. In the process, blood travels out through this
catheter by way of a pump, heat-exchanger, and oxygenator before
returning to the body, prepared to reenter the body with bound oxygen.
Using ELS has previously shown positive results in cardiac arrest
patients. It enhances the coronary blood flow, helping keep heart
tissue alive, which can reduce the time needed before independent
circulation can occur. Additionally, ELS maintains blood flow to other
organs, thus preventing further dysfunction and decreasing later
morbidity. Finally, while supported using ELS, the underlying cause of
the arrest can be diagnosed, assisting with the treatment of this
condition and thus the eventual return of the patient to a normal
state.

To investigate the effects of CPR and ELS on the
survival of sudden cardiac arrest patients, Dr Yih- Sharng Chen and Dr
Jou-Wei Lin, National Taiwan University Hospital, Taipei, Taiwan, and
colleagues performed a three-year study examining patients between the
ages of 18 and 75 years who had experienced in-hospital cardiac arrest
of cardiac origin. In this group, 113 patients had been treated with
only CPR for more than ten minutes, while 59 had been treated with both
ELS and CPR.

The patients who received both measures had a
better survival rates to discharge, better 30=day survival and better
1-year survival than patients who received only conventional CPR. For
each of these endpoints, patients who receieved ELS were approximately
half as likely to die as those receiving only CPR.

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.”

Dr Sung-Woo Lee and Dr Yun-Sik Hong, Korea University Ansan Hospital
Emergency Department, Seoul, South Korea, contributed an accompanying
comment stating that this combination therapy could be useful in
certain situations. “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.”

Cardiopulmonary
resuscitation with assisted extracorporeal life-support versus
conventional cardiopulmonary resuscitation in adults with in-hospital
cardiac arrest: an observational study and propensity analysis
Yih-Sharng
Chen, Jou-Wei Lin, Hsi-Yu Yu, Wen-Je Ko, Jih-Shuin Jerng, Wei-Tien
Chang, Wen-Jone Chen, Shu-Chien Huang, Nai-Hsin Chi, Chih-Hsien Wang,
Li-Chin Chen, Pi-Ru Tsai, Sheoi-Shen Wang, Juey-Jen Hwang, Fang-Yue Lin

Lancet, July 7, 2008
DOI:10.1016/S0140-6736(08)60958-7
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Anna Sophia McKenney

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