Takahiro Nakashima1,2, Teruo Noguchi1, Yoshio Tahara1, Kunihiro Nishimura1, Soshiro Ogata1, Satoshi Yasuda1,2, Daisuke Onozuka3, Naoto Morimura4, Ken Nagao5, David F Gaieski6, Yasufumi Asai7, Hiroyuki Yokota8, Satoshi Nara9, Mamoru Hase10, Takahiro Atsumi11, Tetsuya Sakamoto12. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre. 2. Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University. 3. Department of Health Communication, Kyushu University Graduate School of Medical Sciences. 4. Department of Emergency and Critical Care Medicine, The University of Tokyo. 5. Cardiovascular Centre, Nihon University Hospital. 6. Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University. 7. Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine. 8. Department of Emergency and Critical Care Medicine, Nippon Medical School. 9. Emergency and Critical Care Medical Centre, Teine Keijinkai Hospital. 10. Cardiovascular Centre, Sapporo Teishinkai Hospital. 11. Department of Emergency Medicine, Seirei Hamamatsu General Hospital. 12. Department of Emergency Medicine, Teikyo University.
Abstract
BACKGROUND: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) and sustained ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) or conversion to pulseless electrical activity/asystole (PEA/asystole) benefit more from extracorporeal cardiopulmonary resuscitation (ECPR). Methods and Results: We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, which was a prospective, multicenter, observational study with 22 institutions in the ECPR group and 17 institutions in the conventional CPR (CCPR) group. Patients were divided into 4 groups by cardiac rhythm and CPR group. The primary endpoint was favorable neurological outcome, defined as Cerebral Performance Category 1 or 2 at 6 months. A total of 407 patients had refractory OHCA with VF/pVT on initial electrocardiogram. The proportion of ECPR patients with favorable neurological outcome was significantly higher in the sustained VF/pVT group than in the conversion to PEA/asystole group (20%, 25/126 vs. 3%, 4/122, P<0.001). Stratifying by cardiac rhythm, on multivariable mixed logistic regression analysis an ECPR strategy significantly increased the proportion of patients with favorable neurological outcome at 6 months in the patients with sustained VF/pVT (OR, 7.35; 95% CI: 1.58-34.09), but these associations were not observed in patients with conversion to PEA/asystole. CONCLUSIONS: OHCA patients with sustained VF/pVT may be the most promising ECPR candidates (UMIN000001403).
BACKGROUND: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) and sustained ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) or conversion to pulseless electrical activity/asystole (PEA/asystole) benefit more from extracorporeal cardiopulmonary resuscitation (ECPR). Methods and Results: We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, which was a prospective, multicenter, observational study with 22 institutions in the ECPR group and 17 institutions in the conventional CPR (CCPR) group. Patients were divided into 4 groups by cardiac rhythm and CPR group. The primary endpoint was favorable neurological outcome, defined as Cerebral Performance Category 1 or 2 at 6 months. A total of 407 patients had refractory OHCA with VF/pVT on initial electrocardiogram. The proportion of ECPR patients with favorable neurological outcome was significantly higher in the sustained VF/pVT group than in the conversion to PEA/asystole group (20%, 25/126 vs. 3%, 4/122, P<0.001). Stratifying by cardiac rhythm, on multivariable mixed logistic regression analysis an ECPR strategy significantly increased the proportion of patients with favorable neurological outcome at 6 months in the patients with sustained VF/pVT (OR, 7.35; 95% CI: 1.58-34.09), but these associations were not observed in patients with conversion to PEA/asystole. CONCLUSIONS: OHCA patients with sustained VF/pVT may be the most promising ECPR candidates (UMIN000001403).
Entities:
Keywords:
Extracorporeal life support; Extracorporeal membrane oxygenation; Favorable neurological outcome