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Abstract

Introduction: The effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for patients with out-of-hospital cardiopulmonary arrest (CPA), especially with ventricular fibrillation (VF), has been already reported. However, enough examination has not been accomplished regarding the influence that an electrocardiogram (ECG) pattern of the CPA {VF, pulseless ventricular tachycardia (VT), asystole and pulseless electrical activity (PEA)}.To evaluate whether ECG pattern influences the prognosis of patients treated with ECPR or not, especially the difference between VF/pulseless VT and other ECG patterns. Methods: We analyzed clinical courses of patients who transferred to hospitals due to CPA and were treated with ECPR in SOS-KANTO 2012 preliminary data. SOS-KANTO study is multicenter and prospective study of out-of-hospital CPA including 68 hospitals in Kanto area in Japan. Patients were divided into two groups based on the ECG pattern on arrival at hospital; VP group (VF/pulseless VT) and AP group (asystole/PEA). One-month prognosis was classified in five degrees {overall performance categories (OPC) 1~5} based on Utstein template and was compared between the two groups. Results: The number of patients registered with SOS-KANTO 2012 preliminary data was 6,019. The total of 147 patients was treated with ECPR, and 77 patients had enough data for analysis in those. Thirty-four patients (VF in 33 and pulseless VT in 1) were included in the VP group and 43 (asystole in 16 and PEA in 27) were included in the AP group. There was no significant difference in the duration from the occurrence of CPA to the ECPR start between the both groups. One-month prognosis in the VP group were following; OPC1 (good) in 4 (11.8%), OPC2 (moderate disability) in 2 (5.9%), OPC3 (severe disorder) in 1 (2.9%), OPC4 (vegetative state) in 2 (5.9%) and OPC5 (death) in 25 (69.6%). On the other hand, OPC1 in 1 (2.3%), OPC3 in 2 (4.7%) and OPC5 in 40 (93.0%) in the AP group. One-month survival was significantly (p=0.001, log-rank test) better in the VP group than in the AP group. Conclusions: The better prognosis will be expected when ECPR is introduced to patients with VF/pulseless VT compared with asystole/PEA.