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

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

Methods: A single-center retrospective review of perioperative ECPR 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 ECPR for POCA. Of the 33 patients, 24 (73%) had a cardiac arrest in the cardiac catheterization lab, while 9 (27%) had a cardiac arrest in the operating room or interventional radiology suite. Survival to discharge was 57.6%, of which 17 (89.5%) had neurologically favorable outcomes with cerebral performance category (CPC) scores of 1 or 2 at discharge. The mean total CPR time was significantly lower in the survivor group than in the non-survivor 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 non-survivors.

Conclusions: The use of ECPR for adults with POCA 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, though certain trends were detected between survival groups.