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

Abstract

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.

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

“…After excluding the duplicated papers, review or meeting abstracts, and irrelevant articles, 60 articles were left for further screening by checking the full texts. 47 articles were excluded, of which, seven were overlapped studies [42][43][44][45][46][47][48], seven were performed in pediatric patients [49][50][51][52][53][54][55], two study contained patients with other disease besides CA and the data related to CA could not be obtained separately [16,56], three studies contained CA patients treated with other methods besides ECPR and the data related to ECPR could not be obtained separately [17,57,58], fifteen studies had no sufficient data [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73], and eleven studies only had therapeutic hypothermia arms (without controls) [37,[74][75][76][77][78][79][80][81][82][83]. Two...…”

Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation

“…In refractory VF that is not responding to persistent standard defibrillation, using venous-arterial extra-corporeal membrane oxygenation (ECMO), if available, is the most effective way to improve the survival rate [7]. When ECMO is possible, it requires many hours of effort [8]. Based on our results, DSD can be used as a bridge to ECMO or as a final option to terminate refractory VF.…”

Effect of citywide enhancement of the chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to 2017

“…To improve the outcomes of patients with non-shockable rhythm, post-cardiac arrest treatment such as TTM, which is also associated with good neurologic outcomes in patients with non-shockable rhythm [27], should be actively performed in hospital. In particular, early initiation of ECMO is associated with better neurologic and survival outcomes after OHCA [28,29], and only one patient received ECMO within 60 min after ED arrival in this study. Therefore, the late initiation of ECMO might have resulted in the poorer neurologic and survival outcomes (S1 Table).…”