Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out‐of‐hospital cardiac arrest from the emergency department to intensive care unit in Japan

Abstract

A lack of known guidelines for the provision of extracorporeal cardiopulmonary resuscitation (ECPR) to patients with out-ofhospital cardiac arrest (OHCA) has led to variability in practice between hospitals even in the same country. Because variability in ECPR practice has not been completely examined, we aimed to describe the variability in ECPR practice in patients with OHCA from the emergency department (ED) to the intensive care units (ICU).Methods: An anonymous online questionnaire to examine variability in ECPR practice was completed in January 2020 by 36 medical institutions who participated in the SAVE-J II study. Institutional demographics, inclusion and exclusion criteria, initial resuscitation management, extracorporeal membrane oxygenation (ECMO) initiation, initial ECMO management, intra-aortic balloon pumping/endotracheal intubation/management during coronary angiography, and computed tomography criteria were recorded. Results:We received responses from all 36 institutions. Four institutions (11.1%) had a hybrid emergency room. Cardiovascular surgery was always involved throughout the entire ECMO process in only 14.7% of institutions; 60% of institutions had formal inclusion criteria and 50% had formal exclusion criteria. In two-thirds of institutions, emergency physicians carried out cannulation. Catheterization room was the leading location of cannulation (48.6%) followed by ED (31.4%). The presence of formal exclusion criteria significantly increased with increasing ECPR volume (P for trend <0.001). Intra-aortic balloon pumping was routinely initiated in only 25% of institutions. Computed tomography was routinely carried out before coronary angiography in 25% of institutions. Conclusions:We described the variability in ECPR practice in patients with OHCA from the ED to the ICU.

Association between gasping and survival among out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: The SOS-KANTO 2017 study

“… 11 Our study demonstrated that gasping was associated with improved 30-day survival among OHCA patients with an initial non-shockable or older age. Although ECPR is effective for patients with an initial non-shockable rhythm, 20 , 21 , 22 the indication for ECPR in these patients is unclear. Furthermore, the latest guidelines have not included OHCA patients with an initial non-shockable rhythm as potential candidates for ECPR.…”

“…Currently, the initiation of ECPR depends on institutional protocols. 20 , 21 A recent study demonstrated variations in ECPR application among OHCA patients in Japan, such as the presence of formal protocols, specialty of cannulator, and ECPR location. 20 …”

Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

“…Thirty percent of ECPRs were performed in relatively high-volume ECPR centers. This may be because the proportion of obese patients in Japan is lower than those in Western countries [ 20 ] and because of the high availability of skilled emergency physicians and acute care surgeons in the emergency departments of high-volume institutions [ 20 ]. Since ECPR-related complications are associated with poor outcome [ 30 ], it is necessary to shorten the time to ECMO and to initiate ECPR without complications.…”

“…This study has several limitations. First, this was a retrospective study with variation of inclusion criteria in each participating institution; therefore, we reported the inclusion and exclusion criteria of all 36 SAVE-J II hospitals in another paper [ 20 ]. Second, there was no control group (i.e., a patient group that did not receive ECPR).…”

“…For this study, the following data were collected: patient characteristics, prehospital information, information on hospital arrival, diagnosis and intervention, mechanical support information, time course, body temperature management, intensive care unit (ICU) information, and outcomes [ 19 ]. The characteristics of the participating institutions, including inclusion and exclusion criteria and initial resuscitation management, are described in our previous paper [ 20 ].…”