Extracorporeal cardiopulmonary resuscitation without target temperature management for out-of-hospital cardiac arrest patients prolongs the therapeutic time window: a retrospective analysis of a nationwide multicentre observational study in Japan

Abstract

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.

A Comparison between Conventional and Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

“…In terms of primary outcome, good neurologic outcome at hospital discharge was reported in 2 studies [ 19 , 23 ], while 5 studies reported it at 1 month [ 20 , 22 , 25 , 28 , 30 ], 3 studies at 3 months [ 26 , 28 , 30 ], and 2 studies at 6 months [ 20 , 27 ]; 2 studies reported survival to discharge as their primary outcome [ 7 , 21 ].…”

“…Our analysis included six registry-based studies—four based in Japan, one in Paris, France, and one in Seoul, South Korea [ 20 , 21 , 23 , 25 , 27 , 30 ]. No additional studies from Paris or France were included.…”

“…None of the Japanese registry-based studies (except for the two SAVE-J studies) overlapped with respect to the years over which data were collected. We included 1 hospital-based study from Japan, though there was also no overlap with respect to the years of data collection between this study and the included registry-based studies from Japan [ 25 ]. One hospital-based study from South Korea may have provided some data duplicated in the Korean registry-based study, though we were unable to confirm their participation in the registry [ 22 ].…”

“…Five studies reported favorable neurologic outcomes at discharge [ 7 , 19 , 21 , 22 , 24 ], 4 at 1 month [ 23 , 25 , 27 , 30 ], 5 at 3 months [ 7 , 24 , 26 , 28 , 30 ], and 3 at 6 months [ 20 , 27 , 29 ]. Our analysis found no significant difference in survival or favorable neurologic outcome at hospital discharge ( Figure 4 a) or at 1 month ( Figure 4 b) between patients treated with ECPR and those treated with CPR.…”

“…Only two studies included in this meta-analysis favored CPR with respect to their primary outcome of interest: Bougouin et al (2020) and Kitada et al (2020) [ 21 , 25 ]. Bougouin et al present the findings of a registry analysis conducted in the Paris region [ 21 ].…”