Dong Sun Choi1, Taeyun Kim2, Young Sun Ro3, Ki Ok Ahn4, Eui Jung Lee5, Seung Sik Hwang6, Sung Wook Song7, Kyoung Jun Song8, Sang Do Shin9. 1. Dept. of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro Bundang-gu, Seongnam 463-707, Republic of Korea. Electronic address: emergencychoi@gmail.com. 2. Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea; Dept. of Emergency Medicine, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju-si, Gyeongsangnam-do 52727, Republic of Korea. Electronic address: emkity@gmail.com. 3. Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: ro.youngsun7@gmail.com. 4. Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: arendt@gmail.com. 5. Dept. of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: ironlyj@gmail.com. 6. Dept. of Social Medicine, Inha University School of Medicine, 27 Inhang-ro Jung-gu, Incheon 400-711, Republic of Korea. Electronic address: cyberdoc73@gmail.com. 7. Dept. of Emergency Medicine, Jeju National University Hospital, 15 Aran13-gil, Jeju-si, Jeju 63241, Republic of Korea. Electronic address: sungwook78@gmail.com. 8. Dept. of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: skciva@gmail.com. 9. Dept. of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: shinsangdo@medimail.co.kr.
Abstract
BACKGROUND: The benefit of extracorporeal life support (ECLS) in highly selective patients with out-of-hospital cardiac arrest (OHCA) is supported by previous studies; however, it is unclear whether the effects of ECLS are observed at a population level. This study aimed to determine whether ECLS is associated with improved survival outcomes compared to conventional CPR (cardiopulmonary resuscitation) at a national level. METHODS: We used a Korean national OHCA cohort database from 2009 to 2013. The inclusion criteria were OHCA adults with presumed cardiac aetiology and resuscitation by emergency medical services (EMS). Patients were excluded if their information on prehospital time intervals or clinical outcomes at hospital discharge was incomplete or not captured. The primary outcome was neurologically favourable survival to discharge. We compared the primary outcomes between the ECLS and non-ECLS groups using a multivariable logistic regression and a propensity score matching analysis. RESULTS: Of the 119,077 patients with OHCA, 36,547 were included in the analysis. There were 320 patients who received ECLS. There was no significant difference in neurologically favourable survival to discharge between the ECLS group and the non-ECLS group after adjusting for covariates (adjusted OR, 0.65; 95% CI, 0.41-1.04). In the propensity score-matched cohort, there was also no significant difference between the two groups (adjusted OR, 0.94; 95% CI, 0.41-2.14). CONCLUSIONS: In this propensity score-matched cohort using a nationwide OHCA database, OHCA victims who received ECLS did not show better survival outcomes than those who did not receive ECLS.
BACKGROUND: The benefit of extracorporeal life support (ECLS) in highly selective patients with out-of-hospital cardiac arrest (OHCA) is supported by previous studies; however, it is unclear whether the effects of ECLS are observed at a population level. This study aimed to determine whether ECLS is associated with improved survival outcomes compared to conventional CPR (cardiopulmonary resuscitation) at a national level. METHODS: We used a Korean national OHCA cohort database from 2009 to 2013. The inclusion criteria were OHCA adults with presumed cardiac aetiology and resuscitation by emergency medical services (EMS). Patients were excluded if their information on prehospital time intervals or clinical outcomes at hospital discharge was incomplete or not captured. The primary outcome was neurologically favourable survival to discharge. We compared the primary outcomes between the ECLS and non-ECLS groups using a multivariable logistic regression and a propensity score matching analysis. RESULTS: Of the 119,077 patients with OHCA, 36,547 were included in the analysis. There were 320 patients who received ECLS. There was no significant difference in neurologically favourable survival to discharge between the ECLS group and the non-ECLS group after adjusting for covariates (adjusted OR, 0.65; 95% CI, 0.41-1.04). In the propensity score-matched cohort, there was also no significant difference between the two groups (adjusted OR, 0.94; 95% CI, 0.41-2.14). CONCLUSIONS: In this propensity score-matched cohort using a nationwide OHCA database, OHCA victims who received ECLS did not show better survival outcomes than those who did not receive ECLS.
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