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Background: Extracorporeal cardiopulmonary resuscitation (ECPR) with extracorporeal membrane oxygenation (ECMO) is a promising therapy for out-of-hospital cardiac arrest (OHCA) compared with conventional cardiopulmonary resuscitation (CCPR). The no and low-flow time (NLT), the interval from collapse to reperfusion to starting ECMO or to the return of spontaneous circulation (ROSC) in CCPR, is associated with the neurological outcome of OHCA. Because the effects of target temperature management (TTM) on the outcomes of ECPR are unclear, we compared the neurological outcomes of OHCA between ECPR and CCPR without TTM. Methods: We performed retrospective subanalyses of the Japanese Association for Acute Medicine OHCA registry. Witnessed cases of adult cardiogenic OHCA without TTM were selected. We performed univariate, multivariable and propensity score analyses to compare the neurological outcomes after ECPR or CCPR in all eligible patients and in patients with NLT of > 30 min or > 45 min. Results: We analysed 2585 cases. Propensity score analysis showed negative result in all patients (odds ratio 0.328 [95% confidence interval 0.141-0.761], P = 0.010). However, significant associated with better neurological outcome was shown in patients with NLT of > 30 min or > 45 min (odds ratio 2.977 [95% confidence interval 1.056-8.388], P = 0.039, odds ratio 5.099 [95% confidence interval 1.259-20.657], P = 0.023, respectively). Conclusion: This study revealed significant differences in the neurological outcomes between ECPR and CCPR without TTM, in patients with NLT of > 30 min.

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Distigmine bromide, an anticholinesterase, is available for the treatment of strangury. Because this drug was reported to cause cholinergic crisis as a severe side effect, the clinical dose has been limited. However, cases of cholinergic crisis are still reported. We experienced a case of shock caused by severe pneumonia and paralytic ileus. Initially, the condition was considered as septic shock. However, it was later, diagnosed as cholinergic crisis because the patient took distigmine bromide and the serum cholinesterase level decreased significantly. Because most of the drug is excreted in the feces, drug concentration in the blood increases when gastrointestinal peristalsis decreases, which is observed in conditions such as paralytic ileus, we must be aware that cholinergic crisis may occur in patients with paralytic ileus.