Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study

Abstract

Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002). Conclusions In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

ECPR for out-of-hospital cardiac arrest: more evidence is needed

“…The largest study to date on the use of ECPR for OHCA was recently published, shedding new light on the effectiveness of this approach. Bougouin et al [8] reported on 13,191 OHCA cases in metropolitan Paris. Of the 12,396 patients managed with conventional CPR, 1061 (8.6%) survived to hospital discharge, compared with 44 (8.4%) of 523 ECPR patients.…”

“…It is also important to study other medical interventions alongside ECPR such as early coronary revascularization [11,14]. The authors [8] suggested that ECPR for OHCA should be restricted to patients with shockable rhythms who achieve transient ROSC. This is important, given that shockable rhythms are a surrogate for the potential for revascularization.…”

Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest in relation to organ donation

“…on extracorporeal cardiopulmonary resuscitation (CPR) in patients with an out-of-hospital cardiac arrest (OHCA) using extracorporeal membrane oxygenation (ECMO). 1 An important study in a field where mortality rates remain high and the search for the best therapy and patient selection continues. In the largest ECMO registry to date, there were 13 191 patients who received resuscitation for OHCA of presumed cardiac cause and included 525 patients (4%) managed with extracorporeal-CPR because sustained return of spontaneous circulation (ROSC) was not achieved.…”

“…Among patients treated with extracorporeal-CPR, 8.4% was discharged alive, compared with 8.6% in the conventional-CPR group. 1 This shows that we need to define better which patients might benefit the most from this therapy, such as patients with an initial shockable rhythm, transient ROSC, and limited delay.…”

“…demonstrated that 4% of patients in the extracorporeal-CPR group became an organ donor after brain death compared with 1% in the conventional-CPR group. 1 Although this increase may seem small, it is of significance in an era where organ donors are limited. 2 Whereas the incidence of brain death was higher in extracorporeal-CPR-treated patients in this study, ECMO may preserve other organ function for a possible donation procedure.…”