Effects of extracorporeal cardiopulmonary resuscitation complications on resuscitation outcomes

BACKGROUND: The survival rate of out-of-hospital cardiac arrest (OHCA) and cardiopulmonary arrest on arrival (CPAOA) remains at approximately 10%. Extracorporeal cardiopulmonary resuscitation (ECPR), which uses extracorporeal membrane oxygenation (ECMO) in addition to conventional resuscitation, has potential to improve survival rates. ECPR has many complications, however the complications during ECPR have not been reported in detail. We investigated the effects of these complications on survival. METHODS: We retrospectively evaluated CPAOA patients who underwent ECPR at our center between January 2010 and December 2014. The frequency and type of complications were compiled. Patients were divided into complication and non-complication groups and compared 30-day survival rate. Further, we analyzed how the occurrence of complications during ECPR affect 30-day survival rate by multivariate analysis using the logistic regression analysis. RESULTS: Eighty-four patients were identified. The overall 30-day survival rate was 14.3%. Eight patients (9.5%) had neurologically favorable outcome. Complications were observed in 48 patients (57.1%); the most common complication was puncture site subcutaneous hematoma (N.=28), followed by retroperitoneal bleeding (N.=18), incorrect cannula insertion (N.=11), aberrant cannula (N.=6), intraperitoneal hemorrhage (N.=3), and rectus sheath hematoma (N.=1). Surgical hemostasis was required for 10 patients (15 events). The 30-day survival rate was significantly higher in the noncomplication group than in the complication group (25.0% vs. 6.25%, respectively; P<0.05). The occurrence of complications was the only independent factor affecting 30-day survival (Odds Ratio: 5.0, 95% confidence interval 1.24-20.10). CONCLUSIONS: Complications during ECPR were an independent factor that decreased the 30-day survival of OHCA patients.