ATS March 2009: Thiagarajan RR, Brogan TV, Scheurer MA, Laussen PC, Rycus PT, Bratton SL. Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in adults. Ann Thorac Surg 2009;87:778-85.

In this month’s Annals, Thiagarajan et note that Extracorporeal membrane oxygenation (ECMO) to support cardiopulmonary resuscitation (CPR) has been shown to improve survival in children and adults.In the report (partially excerpted herein), they describe outcome for the use of ECMO to support CPR (E-CPR) in patients > 18 years of age. The multi-institutional data come from the Extracorporeal Life Support Organization (ELSO) registry, 1992 – 2007. Two hundred and ninety-seven (11% of 2,633 adult ECMO uses) involved E-CPR. Median age was 52 years, and most patients had cardiac disease (n = 221; 75%). Survival to hospital discharge was 27%. Brain death occurred in 61 (28%) of nonsurvivors. In a multivariate logistic regression model, pre-ECMO factors including a diagnosis of acute myocarditis and use of percutaneous cannulation lowered odds of mortality, whereas a lower  pre-ECMO arterial pO2 increased odds of mortality. The need for dialysis during ECMO increased odds of mortality. The authors concluded that further studies are warranted to evaluate and better define patients who may benefit from E-CPR. They also note that although survival data are disappointing, all of these patients faced certain mortality without this level of intervention. Is this therapy justified, and will it become standard of care for cardiac centers.

Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/87/3/778 and add your comments in the Dilemmas in Adult Cardiac Surgery Discussion Forum.