Abstract

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm.MethodsAdult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome.ResultsIn total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology.ConclusionsThe outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

Highlights

  • Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-ofhospital cardiac arrest (OHCA)

  • In OHCA patients with an initial shockable rhythm, several studies have reported better survival and neurological outcome in patients treated with ECPR compared with conventional cardiopulmonary resuscitation (CCPR) [4, 5]

  • For in-hospital cardiac arrest patients treated with ECPR, non-shockable rhythm is more frequent as the initial rhythm than shockable rhythm [6, 7]

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Summary

Introduction

Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-ofhospital cardiac arrest (OHCA). Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be a promising treatment for refractory out-of-hospital cardiac arrest (OHCA) [1,2,3]. In OHCA patients with an initial shockable rhythm, several studies have reported better survival and neurological outcome in patients treated with ECPR compared with conventional cardiopulmonary resuscitation (CCPR) [4, 5]. There are only few reports evaluating the efficacy of ECPR in OHCA patients with an initial non-shockable rhythm. This study aimed to evaluate the efficacy of ECPR in OHCA patients with an initial non-shockable rhythm, with reference to the outcomes of patients with an initial shockable rhythm at our center

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