EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics

In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of “Who should I put on ECMO?”  Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important.  Guillaume’s data shows importance of short low times, lower lactates and higher pH values.  The real question is what number for each of these should we consider a hard stop on initiation.  This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial.  He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had >30 minutes of chest compressions.  With many ECMO studies having average arrest to initiation times of > 60 minutes, Josh’s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide.  This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age < 65.   We  conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival.  This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this.   Bibliography: 1: Haas NL, Coute RA, Hsu CH, Cranford JA, Neumar RW. Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-An ELSO registry study
. Resuscitation. 2017 Oct;119:56-62. doi: 10.1016/j.resuscitation.2017.08.003. Epub 2017 Aug 5. PubMed PMID: 1.   2: Reynolds JC, Grunau BE, Elmer J, Rittenberger JC, Sawyer KN, Kurz MC, Singer B, Proudfoot A, Callaway CW. Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates. Resuscitation. 2017 Aug;117:24-31. doi: 10.1016/j.resuscitation.2017.05.024. Epub 2017 May 25. PubMed PMID: 2.   3: Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, Bouvaist H, Chavanon O, Maignan M, Bouzat P, Albaladejo P, Labarère J. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation. 2017 Mar;112:1-10. doi: 10.1016/j.resuscitation.2016.12.011. Epub 2016 Dec 19. Review. PubMed PMID: 3. References 1. Haas N, Coute R, Hsu C, Cranford J, Neumar R. Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-An ELSO registry study
. Resuscitation. 2017;119:56-62. [PubMed] 2. Reynolds J, Grunau B, Elmer J, et al. Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates. Resuscitation. 2017;117:24-31. [PubMed] 3. Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation. 2017;112:1-10. [PubMed]

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