Abstract
BACKGROUND: There is insufficient evidence for a treatment bundle including extracorporeal cardiopulmonary resuscitation (ECPR) and therapeutic hypothermia plus percutaneous coronary intervention (PCI) for out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS). METHODS: From the SAVE-J, a prospective, multicenter, comparative study of ECPR, ACS patients who arrived at the hospital in cardiac arrest after OHCA due to ventricular fibrillation (VF) were included. We investigated whether ECPR and therapeutic hypothermia plus PCI for ACS had neurological benefit. The primary endpoint was favorable 30-day neurological outcome after OHCA. RESULTS: Of the 454 patients meeting the criteria of the SAVE-J, 280 (61.7%) were ACS, including 165 in the ECPR group and 115 in the non-ECPR group. Based on intention-to-treat analysis, frequency of favorable 30-day neurological outcome was 10.3% (17/165) in the ECPR group and 1.7% (2/115) in the non-ECPR group (p<0.001). By per protocol analysis, frequency of favorable 30-day neurological outcome was 11.3% (17/151) in the ECPR group and 2.2% (2/89) in the non-ECPR group (p<0.001). In the ECPR group (n=165), treatment included therapeutic hypothermia in 91.5% and emergency PCI in 90.3%. After adjustment for confounders, in 131 ACS patients treated with ECPR and therapeutic hypothermia plus PCI, longer collapse-to-hospital-arrival interval (adjusted OR, 0·93, 95% CI, 0.87-0.99) and female (adjusted OR, 0·14, 95% CI, 0.02-0.97) resulted in worse neurological outcome, and lower age and longer duration of cooling showed a tendency toward neurological benefits. CONCLUSION: In ACS patients who arrived at the hospital in cardiac arrest after OHCA due to ventricular fibrillation (VF), a treatment bundle including ECPR, therapeutic hypothermia plus PCI was associated with improved neurological outcome.
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