Yoshinori Matsuoka1, Tatsuyoshi Ikenoue2, Natsumi Hata3, Masataka Taguri4, Takahiro Itaya5, Koichi Ariyoshi3, Shunichi Fukuhara6, Yosuke Yamamoto7. 1. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan; Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan. 2. Department of Human Health Science, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-city, Kyoto, 606-8507, Japan. 3. Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan. 4. Department of Data Science, School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0027, Japan. 5. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan. 6. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan. 7. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan. Electronic address: yamamoto.yosuke.5n@kyoto-u.ac.jp.
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.
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.