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1465: ADVANCES IN NEUROLOGIC OUTCOMES AFTER EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION

Introduction/Hypothesis: Extracorporeal Cardiopulmonary Resuscitation (ECPR) -VA-ECMO for refractory cardiac arrest -has grown rapidly. However, its widespread adoption has been limited by poor outcomes often attributed to neurologic complications. Building on our prior work demonstrating good functional outcomes in surviving cardiac surgery ECPR patients, we sought to describe neurologic outcomes in all ECPR patients since increasing utilization and faster mobilization of a dedicated 24/7 VA-ECMO ECPR team. Methods: A retrospective cohort study of adult ECPR from 2016 to 2018 at UMMC was performed with attention to outcomes and utilization of neurologic testing. Survival, discharge disposition and cerebral performance category (CPC), and rates of in-house neurologic complications were tabulated. Two-sample t-tests were performed to assess the predictive value of age, serum lactate, and SOFA at cannulation. Results: Of 200 consecutive VA-ECMO patients, 51 underwent ECPR, 47(92%) suffered inhospital cardiac arrest and 20(39%) were post-op from cardiac surgery. Overall, 25(49%) survived hospitalization and 18(35%) were still alive at most recent follow-up. At discharge, 21(84% of survivors, 41% overall) had a favorable CPC (1-2), 7(28%) discharged to home, 14(56%) transferred to rehab, and 4(16%) transferred to another acute care facility. Eleven(22%) underwent EEG, 24(47%) Head CT, 3(6%) Brain MRI, and 10(20%) were followed by the neurocritical care consult service. Four(8%) were declared brain dead, and 8 additional patients (16%) had one or more neurologic complication (4 ischemic infarcts, 4 seizures, and 3 anoxic injuries). Survivors with good CPC at time of hospital discharge were significantly younger (p<0.05), but age was not associated with mortality or neurologic complications. Patients declared brain dead had significant hyperlactemia at cannulation (p<0.001), and starting lactate also was associated with mortality (p<0.005). Conclusions: ECPR adoption may increase for refractory cardiac arrest as best practices evolve. Favorable neurologic outcome occurred in a majority of survivors, and improved survival amounted to a larger overall proportion with good outcomes. As in prior studies, younger age and serum lactate may help risk stratify ECPR patients.