Association Between Converting Asystole From Initial Shockable ECG Rhythm Before Extracorporeal Cardiopulmonary Resuscitation and Outcome

Abstract

Background: Initial electrocardiogram (ECG) rhythm is a predictor of outcomes in out-of-hospital cardiac arrest (OHCA) in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). However, ECG rhythm often changes before ECPR, and the consequence of this change remains unclear. This study aimed to assess the relationship between the conversion of ECG rhythm from initial shockable rhythm before ECPR and mortality. Patients and Methods: This was a retrospective cohort study of OHCA patients with initial shockable rhythm who underwent ECPR between January 2010 and September 2020. Patients were classified into two groups: asystole (patients whose ECG rhythm converted to asystole at any time before initiating ECPR) and non-asystole (patients whose ECG rhythm did not convert to asystole at any time before initiating ECPR) groups. The primary outcome was in-hospital mortality. Results: A total of 102 patients were included in the study; in-hospital mortality rate was 46.1% (n ¼ 47) and 76 (74.5%) patients had unfavorable neurological outcomes (Cerebral Performance Category: 3-5). There were 33 and 69 patients in the asystole and nonasystole groups, respectively. The mortality rates in the asystole and non-asystole groups were 69.7% and 34.8%, respectively (P ¼ 0.001). On multivariable analysis, the asystole group showed a significant association with mortality (odds ratio, 5.42; 95% confidence interval, 2.11-15.36; P < 0.001). Conclusion: Conversion to asystole before ECPR at any time in patients with OHCA is associated with mortality in patients with an initial shockable ECG rhythm.

In-hospital extracorporeal cardiopulmonary resuscitation for patients with an out-of-hospital cardiac arrest in a semi-rural setting: An observational study on the implementation of a helicopter emergency medical services pathway

“…This happened either before arrival of HEMS, in the presence of HEMS, or on route to hospital (if conveyed). Previous studies have demonstrated that this is a poor prognosticator when ECPR is initiated, 25 and therefore asystole on presentation is often regarded as a contraindication. The relatively high number of patients with a rhythm conversion is most likely the result of the prolonged travel times.…”

Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest - who, when, and where?

“…Based on meta-analyses and observational studies, an initial shockable cardiac rhythm is considered a major prognostic factor for favorable neurologic outcomes for OHCA patients [12]. In addition to initial cardiac rhythm following OHCA, shockable cardiac rhythm upon ECPR initiation was associated with favorable neurological outcome at hospital discharge while conversion to asystole (from an initial shockable rhythm) before ECPR initiation was associated with increased mortality [13 ▪ ].…”

Combination of Hyperoxygenation and Targeted Temperature Management Improves Functional Outcomes of Post Cardiac Arrest Syndrome Irrespective of Causes of Arrest in Rats

“…In consideration of the diverse indications of both therapeutic approaches, it is feasible to achieve the desired therapeutic efficacy on PCAS by selecting appropriate therapy tailored to the cause of CA. Unfortunately, identifying the etiology of CA in a prehospital setting is difficult because the emergency medical service response time is usually more than 8 minutes, during which the initial rhythms of asphyxia and dysrhythmia may have changed spontaneously (12,13). Therefore, a universally effective treatment for CA with unknown etiology is of great need to solve the difficulty of indistinguishability of asphyxial and dysrhythmic CA in comatose patients.…”