Case Series of Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiopulmonary Arrest After Cardiac Surgery

Little is known about the outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiopulmonary arrest occurring after major cardiac surgery. This study aimed to evaluate our institutional experience with ECPR in this setting. We retrospectively reviewed all adult patients who underwent extracorporeal membrane oxygenation (ECMO) for cardiopulmonary arrest within 30 days after major cardiac surgery outside the operating room between 2015 and 2023. Baseline characteristics, operative details, and clinical outcomes were analyzed. A total of 21 patients who underwent ECPR were identified. Index operations included valve surgery (n = 5), coronary artery bypass grafting (CABG) (n = 10), and others. The location of arrest was the intensive care unit (ICU) in 8 patients (38.1%) and the step-down unit in 13 patients (61.9%). Nine patients (42.9%) underwent central cannulation with an open chest, and 12 (57.1%) underwent femoral cannulation with chest compressions. Twelve patients (57.4%) were successfully decannulated, whereas nine (42.6%) died while on ECMO. In-hospital mortality was 47.6% (n = 10) and similar between central and femoral cannulation (44.4 vs. 50.0%; p = NS). Of the 11 in-hospital survivors, 7 (33.3%) were neurologically intact at discharge. Kaplan-Meier analysis showed a 1 year survival rate of 41.2%.