Extracorporeal cardiopulmonary resuscitation in refractory intra-operative cardiac arrest: an observational study of 12-year outcomes in a single tertiary hospital

Refractory intra-operative cardiac arrest is a challenging issue for anaesthetists. In this study, we analysed the outcomes of adult patients who received extracorporeal cardiopulmonary resuscitation for refractory intra-operative cardiac arrest between 2005 and 2016, using data from our institutional extracorporeal membrane oxygenation registry. We defined refractory intra-operative cardiac arrest as the failure of a return of spontaneous circulation after 30 min of cardiopulmonary resuscitation. The primary outcome measure was neurologically intact survival with a cerebral performance category score of 1 or 2 at hospital discharge. Between 2005 and 2016, extracorporeal cardiopulmonary resuscitation was used to treat 23 patients who experienced refractory cardiac arrest in the operating room. The survival rates of neurologically-intact subjects were 9/23 (39%) and 6/23 (26%) at 24 h postoperatively and at hospital discharge, respectively. The main cause of refractory-intra-operative cardiac arrest was haemorrhagic shock in 13 out of 23 (57%) patients, and the neurologically-intact survival rate in these patients was 3/13 (23%) at discharge. Our study showed that approximately a quarter of patients with refractory intra-operative cardiac arrest caused by haemorrhage would receive survival benefit from extracorporeal cardiopulmonary resuscitation. Therefore, extracorporeal cardiopulmonary resuscitation may be a possible option in this clinically-challenging situation.