Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka

Okada, Yohei; Irisawa, Taro; Yamada, Tomoki; Yoshiya, Kazuhisa; Park, Changhwi; Nishimura, Tetsuro; Ishibe, Takuya; Kobata, Hitoshi; Kishimoto, Masafumi; Kim, Sung Hoon; Ito, Yusuke; Sogabe, Taku; Morooka, Takaya; Sakamoto, Haruko; Suzuki, Keitaro; Onoe, Atsunori; Matsuyama, Tasuku; Kobayashi, Daisuke; Nishioka, Norihiro; Matsui, Satoshi; Yoshimura, Satoshi; Kimata, Shunsuke; Kawai, Shunsuke; Makino, Yuto; Kiyohara, Kosuke; Zha, Ling; Kitamura, Tetsuhisa; Iwami, Taku

doi:10.1016/j.resuscitation.2022.06.007

Cited by 16 publications

(5 citation statements)

References 20 publications

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“…Combining PaCO 2 with pre-speci ed criteria(5, 16, 21) (Supplementary Table 2) could further increase the percentage of favorable outcomes. For example, adding PaCO 2 < 70 mmHg to the selection criteria in the CRITICAL study (21), the FO rate will improve from 19-33% with the exclusion of three patients with FO from our cohort.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of arterial carbon dioxide tension during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients receiving extracorporeal resuscitation

Su,

Tsai,

Chen

et al. 2024

Preprint

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Background Current guidelines on extracorporeal cardiopulmonary resuscitation (ECPR) recommend careful patient selection, but precise criteria are lacking. Arterial carbon dioxide tension (PaCO2) has prognostic value in out-of-hospital cardiac arrest (OHCA) patients but has been less studied in patients receiving ECPR. We studied the relationship between PaCO2 during cardiopulmonary resuscitation (CPR) and neurological outcomes of OHCA patients receiving ECPR and tested whether PaCO2 could help ECPR selection. Methods This single-centre retrospective study enrolled 152 OHCA patients who received ECPR between January 2012 and December 2020. Favorable neurological outcome (FO) at discharge was the primary outcome. We used multivariable logistic regression to determine the independent variables for FO and generalised additive model (GAM) to determine the relationship between PaCO2 and FO. Subgroup analyses were performed to test discriminative ability of PaCO2 in subgroups of OHCA patients. Results Multivariable logistic regression showed that PaCO2 was independently associated with FO after adjusting for other favorable resuscitation characteristics (Odds ratio [OR] 0.23, 95% Confidence Interval [CI] 0.08–0.66, p-value=0.006). GAM showed a near-linear reverse relationship between PaCO2 and FO. PaCO2 <70 mmHg was the cutoff point for predicting FO. PaCO2 also had prognostic value in patients with less favorable characteristics, including non-shockable rhythm (OR, 3.78) or low flow time >60 min (OR, 4.66). Conclusion PaCO2 before ECMO implementation had prognostic value for neurological outcomes in OHCA patients. Patients with PaCO2 <70 mmHg had higher possibility of FO, even in those with non-shockable rhythm or longer low-flow duration. PaCO2 could serve as an ECPR selection criterion.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of arterial carbon dioxide tension during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients receiving extracorporeal resuscitation

Su,

Tsai,

Chen

et al. 2024

Preprint

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show abstract

“… 20 Notably, previous studies have indicated that a shorter time to implement ECPR may result in better outcomes, highlighting the potential importance of early recognition of refractory VF/VT and prompt activation of the ECPR team to enhance patient outcomes. 21 , 22 , 23 , 34 Furthermore, prehospital ECPR systems have already been implemented in some regions. 24 , 25 We expect that the models in this study have potential to improve the criteria to activate prehospital ECPR teams.…”

Section: Discussionmentioning

confidence: 99%

Machine learning prediction of refractory ventricular fibrillation in out-of-hospital cardiac arrest using features available to EMS

Rahadian,

Okada,

Shahidah

et al. 2024

Resuscitation Plus

Self Cite

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“…This indicates that the PaCO 2 level could be used as a powerful indicator in addition to traditional selection criteria. Combining PaCO 2 with pre-specified criteria [5,18,23] (Supplementary Table 2) could further increase the percentage of favorable outcomes. For example, adding PaCO 2 < 70 mmHg to the selection criteria in the CRITI-CAL study [23], the FO rate will improve from 19 to 33% with the exclusion of three patients with FO from our cohort.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of arterial carbon dioxide tension during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients receiving extracorporeal resuscitation

Su,

Tsai,

Chen

et al. 2024

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background Current guidelines on extracorporeal cardiopulmonary resuscitation (ECPR) recommend careful patient selection, but precise criteria are lacking. Arterial carbon dioxide tension (PaCO2) has prognostic value in out-of-hospital cardiac arrest (OHCA) patients but has been less studied in patients receiving ECPR. We studied the relationship between PaCO2 during cardiopulmonary resuscitation (CPR) and neurological outcomes of OHCA patients receiving ECPR and tested whether PaCO2 could help ECPR selection. Methods This single-centre retrospective study enrolled 152 OHCA patients who received ECPR between January 2012 and December 2020. Favorable neurological outcome (FO) at discharge was the primary outcome. We used multivariable logistic regression to determine the independent variables for FO and generalised additive model (GAM) to determine the relationship between PaCO2 and FO. Subgroup analyses were performed to test discriminative ability of PaCO2 in subgroups of OHCA patients. Results Multivariable logistic regression showed that PaCO2 was independently associated with FO after adjusting for other favorable resuscitation characteristics (Odds ratio [OR] 0.23, 95% Confidence Interval [CI] 0.08–0.66, p-value = 0.006). GAM showed a near-linear reverse relationship between PaCO2 and FO. PaCO2 < 70 mmHg was the cutoff point for predicting FO. PaCO2 also had prognostic value in patients with less favorable characteristics, including non-shockable rhythm (OR, 3.78) or low flow time > 60 min (OR, 4.66). Conclusion PaCO2 before ECMO implementation had prognostic value for neurological outcomes in OHCA patients. Patients with PaCO2 < 70 mmHg had higher possibility of FO, even in those with non-shockable rhythm or longer low-flow duration. PaCO2 could serve as an ECPR selection criterion.

show abstract

Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka

Cited by 16 publications

References 20 publications

Prognostic value of arterial carbon dioxide tension during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients receiving extracorporeal resuscitation

Prognostic value of arterial carbon dioxide tension during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients receiving extracorporeal resuscitation

Machine learning prediction of refractory ventricular fibrillation in out-of-hospital cardiac arrest using features available to EMS

Prognostic value of arterial carbon dioxide tension during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients receiving extracorporeal resuscitation

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