Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

Abstract

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is the emerging resuscitative strategy to save refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) patients. We investigated whether the receiving hospitals' ECPR capabilities are associated with outcomes in out-of-hospital cardiac arrest (OHCA) patients who have refractory VF or pulseless VT. Methods: In a population-based cohort study performed in Kobe City, Japan, between 2010 and 2017, we identified all OHCA patients who had refractory VF or pulseless VT. Based on their ECPR capabilities, hospitals were categorised into ECPR facilities and conventional cardiopulmonary resuscitation (CCPR) facilities. We compared patient survivals between ECPR facilities and CCPR facilities by applying inverse probability weighting using a propensity score. Results: Of all 10,971 OHCA patients, 518 had refractory VF or pulseless VT. The proportion of favourable neurologic outcomes was 43/188 (22.9%) in ECPR facilities and 28/330 (8.5%) in CCPR facilities. In the propensity analysis, hospitals' ECPR capabilities were associated with favourable neurologic outcomes (adjusted risk difference [ARD], 9.7% [95% confidence interval [CI], 3.7%-15.7%]; adjusted risk ratio [ARR], 2.01 [95% CI, 1.31-3.09]), and overall survival (87/188 [46.3%] vs. 67/330 [20.3%]; ARD, 19.0% [95% CI, 11.1%-26.9%]; ARR, 1.88 [95% CI, 1.45-2.44]). Conclusions: Hospitals' ECPR capabilities were associated with favourable neurologic outcomes in OHCA patients who had refractory VF or pulseless VT. We should take each hospital's ECPR capability into consideration when developing a regional system of care for OHCA.

Initial pH and shockable rhythm are associated with favorable neurological outcome in cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation

“…Refractory cardiac arrest, usually defined as persistent cardiac arrest despite 30 minutes of medical cardiopulmonary resuscitation (CPR) (1), is associated with an extremely low probability of survival with conventional CPR. In this setting, extracorporeal CPR with venoarterial extracorporeal membrane oxygenation (ECMO) has been found to be associated with better neurological outcome compared to conventional CPR (2)(3)(4). A recent analysis of the Extracorporeal Life Support Organization Original Article Initial pH and shockable rhythm are associated with favorable neurological outcome in cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation (ELSO) database showed that the use of extracorporeal CPR (eCPR) has increased during the last decade (5).…”

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support

“…92,93 eCPR is recommended in patients aged < 75 years and those with an initially shockable rhythm, a cardiac etiology or reversible cause of cardiac arrest, a no-flow time of < 5 minutes, an unsuccessful resuscitation despite receiving ALS for > 10 minutes, and a total collapse time of < 60 minutes. [94][95][96][97][98][99][100][101][102][103][104][105][106][107]…”

ECPR—extracorporeal cardiopulmonary resuscitation

“…Matsuok et al in their population-based study in 2019 reported an overall survival of 46.3% (87/188) and 20.3% (67/ 330) in the ECPR and CCPR groups, respectively, out of 518 patients studied. They also reported a favourable neurological outcome of 22.9% (43/188) in the ECPR group as against 8.5% (28/330) in the CCPR group [37]. Dalia et al reported his single-centre experience in 2020.…”