Dr. Joseph Tonna, MD, MS, is a tenured Associate Professor in the Divisions of Cardiothoracic Surgery and Emergency Medicine at the University of Utah. He is the Associate Director of Extracorporeal Membrane Oxygenation (ECMO) Services, as well as the Section Head of Cardiothoracic Critical Care and Medical Director of the Cardiovascular ICU/Cardiothoracic Critical Care. His funded research program focuses on clinical trials in critically ill patients and ECMO. In this podcast Dr. Tonna discusses "Using ECPR During In-Hospital Cardiac Arrest (RESCUE-IHCA).
Link to Abstract
The goal of this study was to create and validate a score that could accurately predict the likelihood of death in adults who had extracorporeal cardiopulmonary resuscitation (ECPR).
Although ECPR is increasingly being utilized to treat refractory in-hospital cardiac arrest (IHCA), survival rates range from 20% to 40%.
The American Heart Association's GWTG-R (Get With the Guidelines–Resuscitation) registry was used to identify adult patients who needed extracorporeal membrane oxygenation for IHCA (ECPR). To predict hospital death, a multivariate survival prediction model and score were created. The findings were externally confirmed in a different cohort of patients who had ECPR for IHCA from the Extracorporeal Life Support Organization registry.
A total of 1,075 patients who received ECPR were included in the study. In both the derivation and validation cohorts, 28% of patients made it to discharge. Age, time of day, initial rhythm, history of renal insufficiency, patient type (cardiac vs noncardiac and medical vs surgical), and duration of the cardiac arrest event were all found to be associated with in-hospital death and were combined into the RESCUE-IHCA (Resuscitation Using ECPR During IHCA) score. The model exhibited adequate calibration (Hosmer and Lemeshow goodness of fit P = 0.079) and good discrimination (area under the curve: 0.719; 95 percent confidence interval: 0.680-0.757). In the external validation cohort, discrimination was reasonable (area under the curve: 0.676; 95 percent confidence interval: 0.606-0.746), and calibration was good (P = 0.66), confirming the model's ability to predict in-hospital death over a wide range of probabilities.
Clinicians can utilize the RESCUE-IHCA score in real time to predict in-hospital death in patients with IHCA who are receiving ECPR.