Figure 3: Signifcant recovery of the heart within a week is observed almost universally in survivors
Serum Troponin LV Ejection Fraction
0 12 24 36 48 60 72
0 2 4 6 8 10 14 12
Figure 2: Comparison of proportional success
in patient outcome along the resuscitation
continuum between the refractory v fb/v tach
protocol and the historical comparison group
n= 30 n= 26
CPC 1 or 2
Univ. of Minnesota
early transport protocol
14 Advances in Resuscitation
with ECMO, and 9 (60%) survived. In 11 patients
with OHCA (all with v fib), ROSC was achieved
in two patients before ECMO was initiated and
in eight of nine patients placed on ECMO. A total
of five OHCA patients (45%) survived, including
three of nine patients who were placed on ECMO.
An Italian study reported on ECMO support in
patients with refractory cardiac arrest (IHCA, n = 24;
OHCA, n = 18). Survival to discharge from inten-
sive care was 46% (11/24) for IHCA and 5% (1/18)
for OHCA (p < 0.05). At six months, survival rates
with good neurological outcome were 38% (9/24)
for IHCA and 5% (1/18) for OHCA.
A German study analyzed a total of 85 consecutive
adult patients treated with ECLS. Thirty-day survival was 42% (25/59) in patients with IHCA and 15%
(4/26) in patients with OHCA (p < 0.02). Duration
of CPR was independent risk factor for mortality.
In the U.S., one study reported 26 cases where
patients received ECMO (and reperfusion when
indicated) over a seven-year period, of whom 11
(42%) presented with v fib/v tach. Of 15 patients
with OHCA, one patient ( 6.6%) who presented
with v fib/v tach survived to discharge and made
a full neurologic recovery. Survival to discharge
was 27.3% (3/11) for IHCA.
Inconsistent results were found in some studies
comparing ECPR vs. conventional CPR in OHCA.
A study from South Korea, found similar rates of
survival to hospital discharge in OHCA patients
with prolonged conventional cardiopulmonary
resuscitation (CCPR) compared with patients who
received ECPR ( 19.4% [86/444] vs. 16. 4 [9/55]).
However, propensity score matching of patients
with ≥ 21 minutes of CPR duration showed neurological outcome at 3 months to be more favorable with ECPR than with CCPR (14.5 vs. 8.1%).
A Japanese study analyzed data from 162 adult
patients with witnessed OHCA of cardiac origin who
had undergone cardiopulmonary resuscitation for
longer than 20 minutes. Survival to discharge was
32.1% (17/53) with ECPR and 6.4% (7/109) with
conventional CPR. Matched propensity analysis
showed significantly higher neurologically intact
survival at three months with ECPR vs. conventional
Despite significant troponin elevations, survivors’ (blue) cardiac function almost recovers to normal in refractory OHCA
patients treated with ECMO-facilitated PCI under the University of Minnesota Protocol. The presence of very high troponins is
associated with brain injury. Troponin of > 200 ng/mL are not uncommon in patients that develop severe anoxic injury early on.