Neurological outcomes after extracorporeal cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest: a retrospective observational study in a rural tertiary care center.

Katsunori Mochizuki,Tomomi Iwashita,Hiroshi Imamura,Kazufumi Okamoto

doi:10.1186/2052-0492-2-33

Abstract

BackgroundIn a rural region with few medical resources, we have promoted the strategy that if an out-of-hospital cardiac arrest (OHCA) patient is likely reversible, he or she should be transported directly from the scene of cardiac arrest to the only tertiary care center where extracorporeal cardiopulmonary resuscitation (ECPR) is readily available. We investigated 1-month survival and neurological outcomes after ECPR in OHCA patients at this center.MethodsWe implemented a retrospective review of OHCA patients of heterogeneous origin in whom ECPR was performed. Demographic characteristics, cardiopulmonary resuscitation, ECPR details, and neurological outcomes were evaluated. Cerebral performance categories were used to assign each patient to favorable or unfavorable outcome groups.ResultsFifty OHCA patients underwent ECPR. Presumed causes of OHCA were cardiac etiology in 32 patients, accidental hypothermia in 7 patients, and other causes in 11 patients. Overall, 13 patients (26%) survived and 10 patients (20%) had favorable outcomes. Of the 32 patients with OHCA of cardiac origin, 5 patients (16%) had favorable outcomes. Of the seven patients with OHCA of hypothermic origin, five patients (71%) had favorable outcomes. No clinically reliable predictors to identify ECPR candidates were found. However, all nine OHCA patients over 70 years of age had unfavorable outcomes (P = 0.224). In addition, all seven patients who satisfied the basic life support termination-of-resuscitation rule had unfavorable outcomes (P = 0.319).ConclusionsECPR can be a useful means to rescue OHCA patients who are unresponsive to conventional cardiopulmonary resuscitation in a rural tertiary care center, in a manner similar to that observed in the urban regions.

Highlights

In a rural region with few medical resources, we have promoted the strategy that if an out-of-hospital cardiac arrest (OHCA) patient is likely reversible, he or she should be transported directly from the scene of cardiac arrest to the only tertiary care center where extracorporeal cardiopulmonary resuscitation (ECPR) is readily available
We conducted a retrospective review of the Advanced Emergency and Critical Care Center database of Shinshu University Hospital from April 2004 to March 2013 and selected all patients, 10 years of age or older and supported with ECPR for OHCA, who were transported after failed conventional CPR including defibrillation
Patient characteristics and overall outcomes During the study period, a total of 1,018 OHCA patients were transported to our center by ambulance

Summary

Introduction

In a rural region with few medical resources, we have promoted the strategy that if an out-of-hospital cardiac arrest (OHCA) patient is likely reversible, he or she should be transported directly from the scene of cardiac arrest to the only tertiary care center where extracorporeal cardiopulmonary resuscitation (ECPR) is readily available. We investigated 1-month survival and neurological outcomes after ECPR in OHCA patients at this center. Encouraging results of ECPR for CA of cardiac origin have been reported for in-hospital cardiac arrest (IHCA) in adults and children [4,5]. The rates of neurologically favorable IHCA survival have been reported as 20% in adults [4] and 38% in children [5]. The favorable results obtained in IHCA patients cannot be directly extrapolated to OHCA patients because of longer transport times and possible delay in initiating ECPR. The rates of neurologically favorable survival after OHCA of cardiac origin have been reported as 12% and 15% in studies of urban regions [6,7]

Methods

Results

Discussion

Conclusion