Abstract Body: Introduction - Several medications used during cardiac arrest have been associated with poor neurological outcomes. As most patients who sustain cardiac arrest die, the effect of ACLS medications on neurologic outcomes is unassessable. For patients treated with ECPR, hemodynamic survival is assured, and thus the ability to assess neurologic outcomes. The impact of these medications on neurologic outcomes in ECPR have not yet been described.
Hypothesis - We hypothesized that non-antiarrhythmic medications and increasing doses of epinephrine given during ECPR cannulations are associated with poor neurological outcomes.
Aim - Our goal was to quantify the effects of intra-arrest medications on cerebral performance category (CPC) score at hospital discharge.
Methods - We conducted a retrospective Extracorporeal Life Support Organization registry-based analysis. The primary outcome was CPC score at hospital discharge. Cumulative odds models assessed association between either (1) binary receipt of a medication or (2) the number of epinephrine milligrams given, and CPC score. For all models, CPC 5 is the reference value. The model reports a tiered output for each CPC, reporting the probability of having a score lower than each CPC level. To minimize inherent bias in the receipt of ACLS drugs, we used inverse probability treatment weights balancing on age, total CPR time, initial rhythm, and pre-cannulation neurologic comorbidity.
Results - As seen in Figure 1, antiarrhythmics were more likely to have a better neurological outcome (amiodarone p < 0.05 for CPC 1 and 2 cutoffs, lidocaine p < 0.001 for CPC 1-3 cutoffs). Intra-arrest sodium bicarbonate resulted in a lower likelihood of a CPC < 2-3. There was no significant difference in CPC score among adults who received intra-arrest calcium. The unweighted cumulative effects model demonstrated a dose-dependent trend towards harm for CPC cutoffs ≤ 2-4. All effect estimates from the weighted model indicate a statistically significant, dose-dependent association of epinephrine with worse neurological outcomes (Figure 2).
Conclusion - With ECPR, compared to conventional resuscitation techniques, ROSC is an eventuality. Consequently, the role of medications whose purpose is to achieve ROSC is unclear in patients being cannulated for ECPR. Our data support that increasing doses of epinephrine and non-antiarrhythmic ACLS medications both worsen the probability of neurologically-intact survival for patients who undergo ECPR.