Shorter Interval from Witnessed Out-Of-Hospital Cardiac Arrest to Reaching the Target Temperature Could Improve Neurological Outcomes After Extracorporeal Cardiopulmonary Resuscitation with Target Temperature Management: A Retrospective Analysis of a Japanese Nationwide Multicenter Observational Registry

Yamada, Shu; Kaneko, Tadashi; Kitada, Maki; Harada, Masahiro; Takahashi, Takeshi

doi:10.1089/ther.2020.0045

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…However, there are no clear recommendations to suggest that TTM could provide an additional therapeutic effect to ECPR. (Our previous studies showed favorable neurological outcome, in ECPR with TTM: 17% [7], ECPR without TTM: 7% [6]. )…”

Section: Introductionmentioning

confidence: 81%

“…Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising strategy for OHCA patients, especially when performed using veno-arterial (VA)-extracorporeal membrane oxygenation (ECMO). We previously reported that ECPR without TTM could prolong the therapeutic time window of OHCA compared with CCPR without TTM [6], and a shorter interval from collapse to target temperature (ICTT) in ECPR with TTM could improve the neurological outcomes of patients compared with CCPR with TTM [7].…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal cardiopulmonary resuscitation with temperature management could improve the neurological outcomes of out-of-hospital cardiac arrest: a retrospective analysis of a nationwide multicenter observational study in Japan

et al. 2022

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Background Target temperature management (TTM) is an effective component of treating out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation in conventional cardiopulmonary resuscitation. However, therapeutic hypothermia (32–34 °C TTM) is not recommended based on the results of recent studies. Extracorporeal cardiopulmonary resuscitation (ECPR) with veno-arterial extracorporeal membrane oxygenation is another promising therapy for OHCA, but few studies have examined the effectiveness of ECPR with TTM. Therefore, we hypothesized that ECPR with TTM could have the effectiveness to improve the neurological outcomes for adults following witnessed OHCA, in comparison to ECPR without TTM. Methods We performed retrospective subanalyses of the Japanese Association for Acute Medicine OHCA registry. We focused on adults who underwent ECPR for witnessed OHCA. We performed univariate (the Mann–Whitney U test and Fisher’s exact test), multivariable (logistic regression analyses), and propensity score analyses (the inverse probability of the treatment-weighting method) with to compare the neurological outcomes between patients with or without TTM, among all eligible patients, patients with a cardiogenic cause, and patients divided into subgroups according to the interval from collapse to pump start (ICPS) (> 30, > 45, or > 60 min). Results We analyzed data for 977 patients. Among 471 patients treated with TTM, the target temperature was therapeutic hypothermia in 70%, and the median interval from collapse to target temperature was 249 min. Propensity score analysis showed a positive association between TTM and favorable neurological outcomes in all patients (odds ratio 1.546 [95% confidence interval 1.046–2.286], P = 0.029), and in patients with ICPS of > 30 or > 45 min, but not in those with ICPS of > 60 min. The propensity score analysis also showed a positive association between TTM and favorable neurological outcomes in patients with a cardiogenic cause (odds ratio 1.655 [95% confidence interval 1.096–2.500], P = 0.017), including in all ICPS subgroups (> 30, > 45, and > 60 min). Conclusion Within patients who underwent ECPR following OHCA, ECPR with TTM could show the potential of improvement in the neurological outcomes, compared to ECPR without TTM.

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Section: Introductionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation with temperature management could improve the neurological outcomes of out-of-hospital cardiac arrest: a retrospective analysis of a nationwide multicenter observational study in Japan

et al. 2022

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“…More recently, initiating ECMO during CPR (ECPR) has been developed as a means of improving circulation and tissue perfusion during resuscitative efforts. [75][76][77] Several observational studies have suggested a benefit of ECPR with improved neurologic outcome. 76,78 Since body temperature regulation during cardiopulmonary bypass has been performed for decades, 79 ECMO may be a viable method of providing TTM.…”

Section: Extracorporeal Temperature Managementmentioning

confidence: 99%

“…For example, an analysis of a Japanese registry showed that time to target temperature was reduced and an association with higher rate of good neurologic outcome (CPC 1–2) when ECPR was combined with TTM compared to conventional CPR, so long as target temperature was achieved in a timely manner. 77 In an observational Australian study, when ECPR with TTM was incorporated into a regional protocol for selected patients with refractory cardiac arrest, the survival-to-discharge rate was 53.8%, all with good neurologic function (CPC = 1). 80 As many as 60% of ECMO centers provide ECPR for refractory cardiac arrest and more than half of those centers provide concomitant TTM.…”

Section: Introductionmentioning

confidence: 99%

Contemporary targeted temperature management: Clinical evidence and controversies

et al. 2022

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Advancements in cardiac arrest and post-cardiac arrest care have led to improved survival to hospital discharge. While survival to hospital discharge is an important clinical outcome, neurologic recovery is also a priority. With the advancement of targeted temperature management (TTM), the American Heart Association guidelines for post-cardiac arrest care recommend TTM in patients who remain comatose after return of spontaneous circulation (ROSC). Recently, the TTM2 randomized controlled trial found no significant difference in neurologic function and mortality at 6-months between traditional hypothermia to 33°C versus 37.5°C. While TTM has been evaluated for decades, current literature suggests that the use of TTM to 33° when compared to a protocol of targeted normothermia does not result in improved outcomes. Instead, perhaps active avoidance of fever may be most beneficial. Extracorporeal cardiopulmonary resuscitation and membrane oxygenation can provide a means of both hemodynamic support and TTM after ROSC. This review aims to describe the pathophysiology, physiologic aspects, clinical trial evidence, changes in post-cardiac arrest care, potential risks, as well as controversies of TTM.

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“…Prior studies have reported mixed findings, with some suggesting that ECPR may lead to improved mortality and neurological outcomes in OHCA patients compared to conventional CPR [10][11][12]. Nevertheless, other articles have demonstrated minimal or no effect on survival, while systematic reviews on this topic have produced conflicting results [10,[12][13][14][15]. These discrepancies are likely attributable to the included studies' inherent heterogeneity and selection method variations, resulting in survival rates ranging widely from 15% to 50% [10,13,16,17].…”

Section: Introductionmentioning

confidence: 99%

How effective is extracorporeal life support for patients with out-of-hospital cardiac arrest initiated at the emergency department? A systematic review and meta-analysis

Wongtanasarasin,

Krintratun,

Techasatian

et al. 2023

PLoS ONE

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Background Extracorporeal cardiopulmonary resuscitation (ECPR) is commonly initiated for adults experiencing cardiac arrest within the cardiac catheterization lab or the intensive care unit. However, the potential benefit of ECPR for these patients in the emergency department (ED) remains undocumented. This study aims to assess the benefit of ECPR initiated in the ED for patients with out-of-hospital cardiac arrest (OHCA). Methods We conducted a systematic review and meta-analysis of studies comparing ECPR initiated in the ED versus conventional CPR. Relevant articles were identified by searching several databases including PubMed, EMBASE, Web of Science, and Cochrane collaborations up to July 31, 2022. Pooled estimates were calculated using the inverse variance heterogeneity method, while heterogeneity was evaluated using Q and I2 statistics. The risk of bias in included studies was evaluated using validated bias assessment tools. The primary outcome was a favorable neurological outcome at hospital discharge, and the secondary outcome was survival to hospital discharge or 30-day survival. Sensitivity analyses were performed to explore the benefits of ED-initiated ECPR in studies utilizing propensity score (PPS) analysis. Publication bias was assessed using Doi plots and the Luis Furuya-Kanamori (LFK) index. Results The meta-analysis included a total of eight studies comprising 51,173 patients. ED-initiated ECPR may not be associated with a significant increase in favorable neurological outcomes (odds ratio [OR] 1.43, 95% confidence interval [CI] 0.30–6.70, I2 = 96%). However, this intervention may be linked to improved survival to hospital discharge (OR 3.34, 95% CI 2.23–5.01, I2 = 17%). Notably, when analyzing only PPS data, ED-initiated ECPR demonstrated efficacy for both favorable neurological outcomes (OR 1.89, 95% CI 1.26–2.83, I2 = 21%) and survival to hospital discharge (OR 3.37, 95% CI 1.52–7.49, I2 = 57%). Publication bias was detected for primary (LFK index 2.50) and secondary (LFK index 2.14) outcomes. Conclusion The results of this study indicate that ED-initiated ECPR may not offer significant benefits in terms of favorable neurological outcomes for OHCA patients. However, it may be associated with increased survival to hospital discharge. Future studies should prioritize randomized trials with larger sample sizes and strive for homogeneity in patient populations to obtain more robust evidence in this area.

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Cited by 9 publications

References 17 publications

Extracorporeal cardiopulmonary resuscitation with temperature management could improve the neurological outcomes of out-of-hospital cardiac arrest: a retrospective analysis of a nationwide multicenter observational study in Japan

Extracorporeal cardiopulmonary resuscitation with temperature management could improve the neurological outcomes of out-of-hospital cardiac arrest: a retrospective analysis of a nationwide multicenter observational study in Japan

Contemporary targeted temperature management: Clinical evidence and controversies

How effective is extracorporeal life support for patients with out-of-hospital cardiac arrest initiated at the emergency department? A systematic review and meta-analysis

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