1138: Surgical Critical Care-Led Extracorporeal Cardiopulmonary Resuscitation Improves Volume and Outcomes

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has gained traction as a viable salvage option for cardiac arrest patients, with most programs led by cardiothoracic surgeons. Critical care surgeons possess the unique combination of the necessary surgical and resuscitation skills, and comfort with urgent interventions. Additionally, they maintain a continuous physical presence in the hospital that other specialties often lack. We hypothesized that an ECPR program led by a surgical intensivists would increase access to care and volume while also improving quality. Methods: A retrospective review was performed of a prospectively maintained database at a single center that has provided ECPR since 2012, with the surgical critical care division assuming leadership of the program in 2018. Volume and survival to discharge pre- and post-2018 were compared. Patient demographics and clinical parameters were assessed for risk factors associated with survival to discharge neurologically intact (cerebral performance score 1-2) using logistic regression in the post-2018 cohort. Statistically significant variables from univariable analysis were included in a stepwise selection process to construct a multivariable model. Results: From 2018-June 2022, 133 patients were supported with ECPR with 38% survival to discharge improving from 28% (7/25) during 2012-2017. Patients were 59 years old (interquartile range, 44-65 yr), 68% male, and presenting most frequently with cardiogenic shock (37%). Survival to discharge neurologically intact (SNI) was 29% (38/133). Male sex, subsequent catheterization lab and/or advanced heart failure therapies, increased hospital length of stay (LOS), and STEMI/NSTEMI were associated with increased SNI. Left sided arterial cannulation, same side A&V cannulation, increased lactate, anoxic brain injury (ABI), and cardiogenic shock were associated with decreased SNI. Multivariable analysis identified same side A&V cannulation (Odds Ratio (OR): 3.1, 95%CI: 1.2-8.3), left arterial cannulation (OR: 3.2, 95%CI: 1.14-8.7), ABI (OR: 34.7, 95%CI: 3.4-359), and shorter LOS (OR per 7-day increase: 0.75, 95%CI: 0.63-0.88) as risk factors for not achieving SNI. Conclusions: An ECPR program led by a surgical critical care team can increase access to extracorporeal support and improve outcomes.