Prognostic Impact of No-Flow Time on 30-Day Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Who Received Extracorporeal Cardiopulmonary Resuscitation

Abstract

Background: How the time sequence of cardiopulmonary resuscitation (CPR) procedures is related to clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. This study examined the impact of the time interval from collapse to start of CPR (no-flow time, NF time) and the time interval from start of CPR to implementation of extracorporeal CPR (ECPR) (low-flow time, LF time) on neurological outcomes. Methods and Results: During the period from 2010 to 2015, we enrolled 85 patients who received ECPR. Fourteen patients (16.5%) showed favorable 30-day neurological recovery. NF time was shorter in the favorable neurological recovery group than in the unfavorable recovery group (1.4±3.0 vs. 5.2±5.8 min, P<0.05), though combined NF+LF times were similar in the 2 groups (50.1±13.2 vs. 55.1±14.8 min, P=0.25). Multivariate logistic regression analysis indicated that pupil diameter at arrival and NF time were independently associated with favorable neurological recovery. The optimal cutoff value of NF time to predict favorable neurological recovery was 5 min (area under curve: 0.70, P<0.05; sensitivity, 85.7%; specificity, 52.1%). Conclusions: The results suggest that NF time is a better predictor than NF+LF time for neurological outcomes in OHCA patients who received ECPR, and that start of CPR within 5 min after collapse is crucial for improving neurological outcomes followed by use of ECPR.

Prompt Extracorporeal Cardiopulmonary Resuscitation with Left Ventricular Unloading by IMPELLA Improves Outcome of Patients with Refractory Cardiac Arrest: A Single-Site Retrospective Cohort Study

“…Previous studies showed that E-CPR has signi cant bene cial effect on both early patient survival and favorable neurological outcome, [15] [16] Murakami et al recently reported that 30-day neurological outcome can be predicted by the interval from collapse to start of CPR better than the interval from collapse to start E-CPR time. [11] In the current study, we did not investigate the interval from collapse to CPR and the interval from collapse to E-CPR appeared to be shorter (< 36 minutes) than their report in all treatment groups (favorable and unfavorable neurological groups were, 50.1 and 55.1 minutes, respectively [11]). In their study, rates of CPC 1 or 2 of total collapse duration between 0 to 45 minutes were 19.2% and that of ECPELLA in the current study was 31%, whereas IABP + VA-ECMO and VA-ECMO were 13% and 7%, respectively.…”

Prompt extracorporeal cardiopulmonary resuscitation with left ventricular unloading by IMPELLA improves the outcome of patients with refractory cardiac arrest: A single-site retrospective cohort study

“…[15] [16] Murakami et al recently reported that 30-day neurological outcome can be predicted by the interval from collapse to start of CPR better than the interval from collapse to start E-CPR time. [11] In the current study, we did not investigate the interval from collapse to CPR, and the interval from collapse to E-CPR appeared to be shorter (<36 minutes) than their report in all treatment groups (favorable and unfavorable neurological groups were 50.1 and 55.1 minutes, respectively [11]). In their study, the rates of CPC 1 or 2 of total collapse duration between 0 and 45 minutes were 19.2% and that of ECPELLA in the current study was 31%, whereas IABP+VA-ECMO and VA-ECMO were 13% and 7%, respectively.…”

Impact of extracorporeal CPR with transcatheter heart pump support (ECPELLA) on improvement of short-term survival and neurological outcome in patients with refractory cardiac arrest – A single-site retrospective cohort study

“…Exclusion criteria included 1) apparent aortic dissection prior to the E-CPR; 2) non-cardiac origins including severe trauma and/or stroke; and 3) known poor prognosis or terminal malignancies. 16. , 17.…”