Extracorporeal life support and survival after out-of-hospital cardiac arrest in a nationwide registry: A propensity score-matched analysis

Choi, Dong Sun; Kim, Taeyun; Ro, Young Sun; Ahn, Ki Ok; Lee, Eui Jung; Hwang, Seung-Sik; Song, Sung Wook; Song, Kyoung Jun; Shin, Sang Do

doi:10.1016/j.resuscitation.2015.11.013

Cited by 107 publications

(96 citation statements)

References 18 publications

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“…For patients undergoing ECPR following OHCA, the observed overall rate of PCI (26.3%) was lower than that previously reported by Kagawa [22] (88%), Yannopoulos [15] (67%), Avalli [2] (61%), Sakamoto [13] (54.8%), Stub [14] (42%), Bellezzo [3] (40%), Maekawa [11] (39.6%), Kagawa [9] (38%), and Choi [4] (31%). While the retrospective nature of this study cannot assess causation, there was no significant difference in survival between patients who underwent PCI (28.1%) and those who did not (27.5%).…”

Section: Discussionmentioning

confidence: 56%

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

et al. 2017

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Aim Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy for refractory cardiac arrest. The purpose of this study was to analyze and report characteristics and outcomes of adult patients treated with ECPR after out-of-hospital cardiac arrest (OHCA) in a large international registry. Methods The Extracorporeal Life Support Organization’s Extracorporeal Life Support Registry was queried for adult cardiac arrests with arrest location of “EMT Transport” or “Outside Hospital.” Results From 2010–2016, 217 cases of ECPR following OHCA were reported in Europe (47%), Asia-Pacific (29%), and North America (24%). The median age was 52 years (IQR 45–62, range 18–87); 73% were male. The median duration of ECPR was 47 h (IQR 17–94, range 0–711). Reported complications included hemorrhage (31.3%), limb complications (11.1%), circuit complications (8.8%), infection (7.4%), and seizures (5.5%). The rate of percutaneous coronary intervention (PCI) was higher in Europe (35.6%) and Asia-Pacific (25.8%) than North America (9.4%; p < 0.01). Survival to hospital discharge was 27.6% (95% CI 22.1–34.0%), and male gender was independently associated with mortality (adjusted odds ratio 2.1 [95% CI 1.1–4.2], p < 0.05). Survival did not differ by region, race, age, or year. Brain death was reported in 16.6% [95% CI 12.2–22.1%]; organ donation rate was not reported. Conclusion This international analysis of ECPR for refractory OHCA reveals a survival rate of 27.6%, demonstrates association of male gender with mortality, and highlights regional differences in PCI utilization. These results will help inform implementation and research of this potentially life-saving strategy for refractory OHCA.

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Section: Discussionmentioning

confidence: 56%

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

et al. 2017

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“…Therefore, generalisability of these findings is limited. Although two studies include over 100 patients undergoing ECPR, both studies did not evaluate the association between survival and the time from arrest to ECPR …”

Section: Discussionmentioning

confidence: 99%

Time from arrest to extracorporeal cardiopulmonary resuscitation and survival after out‐of‐hospital cardiac arrest

Park

Song

Shin

et al. 2019

Emerg Medicine Australasia

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Objectives: The association between the time from arrest to extracorporeal cardiopulmonary resuscitation (ECPR) and survival from out-ofhospital cardiac arrest (OHCA) is unclear. The aim of this study was to determine whether time to ECPR is associated with survival in OHCA. Methods: We analysed the Korean national OHCA registry from 2013 to 2016. We included adult witnessed OHCA patients with presumed cardiac aetiology who underwent ECPR. Patients were excluded if their arrest times or outcomes were unknown. The primary outcome was survival to discharge. Multivariable logistic regression analysis controlling for potential confounders was conducted and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated to determine the association between time to ECPR and survival. Results: There were 40 352 witnessed OHCAs with presumed cardiac aetiology. One hundred and forty patients had ECPR applied on arriving at their ED, 13 of these patients survived to discharge and seven were neurologically intact. Median time from arrest to ECPR was 74 min (IQR 61-90). Time from arrest to ECPR was significantly and inversely associated with survival to discharge for every 10 min increase in time (AOR 0.73, 95% CI 0.53-1.00) in 10 min intervals. AOR for time from arrest to ECPR ≤60 min was independently associated with improved survival (AOR 6.48, 95% CI 1. 54-27.20). Conclusion: Early initiation of ECPR is associated with improved survival after OHCA. Because we analysed a nationwide OHCA registry, which lacks uniform selection criteria for ECPR, further prospective study is warranted.

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“…Unfortunately, the cost/benefit of eCPR compared to conventional CPR is not known, as most studies are retrospective 10,17,18 or observational, 8,11 and few control for or describe cannulation techniques or post-cannulation management; 6 as such, there is a profound knowledge gap around the absolute benefit, use appropriateness and ideal patient management of eCPR, which may lead to inappropriate use and outcome disparities.…”

Section: Introductionmentioning

confidence: 99%

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO)

et al. 2016

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Purpose To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. Methods We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. Results Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤ 3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow®. Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists. Conclusions Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable.

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Extracorporeal life support and survival after out-of-hospital cardiac arrest in a nationwide registry: A propensity score-matched analysis

Cited by 107 publications

References 18 publications

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

Time from arrest to extracorporeal cardiopulmonary resuscitation and survival after out‐of‐hospital cardiac arrest

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO)

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