Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

Abstract

Background The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications. Methods We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2. Results A total of 1644 patients with OHCA were included in this study. The patient age was 18–93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45–66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively. Conclusions In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.

Transient return of spontaneous circulation related to favourable outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

“…This study was a secondary analysis of the SAVE-J II study, which was a retrospective multicentre registry study of OHCA patients resuscitated with ECPR, involving 36 participating institutions in Japan. 22 The study design and data collection methods of the SAVE-J II study have been previously described. 22 The SAVE-J II study included consecutive OHCA patients aged ≥18 years who were resuscitated with ECPR.…”

“… 22 The study design and data collection methods of the SAVE-J II study have been previously described. 22 The SAVE-J II study included consecutive OHCA patients aged ≥18 years who were resuscitated with ECPR. They were admitted to the participating institutions between 1 January 2013 and 31 December 2018.…”

“…Transient ROSC was defined as any palpable pulse or measurable blood pressure ≥1 min before ECMO initiation, either before and after hospital arrival. 22 The primary outcome was a favourable neurological outcome, and the secondary outcome was survival to hospital discharge. A favourable neurological outcome was defined as a cerebral performance category (CPC) of 1–2, whereas an unfavourable outcome was defined as a CPC of 3–5.…”

“…It has been reported that extracorporeal cardiopulmonary membrane oxygenation (ECMO) assisted resuscitation, also known as extracorporeal resuscitation (ECPR), is potentially effective for refractory CPA. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 The 2020 American Heart Association guidelines for Class IIb recommend the use of ECPR for refractory CPA with a potentially reversible aetiology. 8 While ideal candidates for ECPR initiation and its optimal timing are currently being investigated, the outcome-related factors in patients who receive ECPR are similar to those of OHCA patients who achieve ROSC with conventional CPR, such as younger age, shorter arrest duration (time from arrest to ECMO initiation), witnessed arrest, and shockable initial cardiac rhythm.…”

“… 8 While ideal candidates for ECPR initiation and its optimal timing are currently being investigated, the outcome-related factors in patients who receive ECPR are similar to those of OHCA patients who achieve ROSC with conventional CPR, such as younger age, shorter arrest duration (time from arrest to ECMO initiation), witnessed arrest, and shockable initial cardiac rhythm. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 In addition, recent ECPR-related studies have reported that the experience of transient ROSC before ECMO initiation was also associated with favourable outcomes in refractory CPA; however, the numbers of included patients were relatively small. Furthermore, details concerning when transient ROSC was achieved (before or after hospital arrival) were not reported in these studies.…”