Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Yo Sep Shin,Youn-Jung Kim,Dong Woo Seo,Won Young Kim,Seung Mok Ryoo,Shin Ahn,Chang Hwan Sohn

doi:10.1038/s41598-020-79283-1

Yo Sep Shin, Youn-Jung Kim + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-79283-1

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Abstract

Precise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

Highlights

Precise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA)
In our analyses we found that when applying the inclusion and exclusion criteria we set, the group who received ECPR had higher proportion of a good neurologic status at 6-months (33.3% vs 5.0%) and 1-month (26.7% vs 5.0%) in comparison with the group receiving conventional CPR (CCPR)
Of patients treated with ECPR, those who had good neurologic status at 6 months had shorter low-flow time, less use of epinephrine during CPR, and longer duration on extracorporeal membrane oxygenation (ECMO) and hospital stays compared with those with poor neurologic status

Summary

Introduction

Precise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. Current recommendations suggest using ECPR for select cardiac arrest patients who are refractory to initial conventional CPR (CCPR), which is usually 10 min[10,11,12]. There is growing evidence that carefully selected patients with in-hospital cardiac arrest can benefit from organ perfusion, thereby potentially improving outcomes of in-hospital cardiac arrest, subsequent outcomes of ECPR in OHCA were inconsistent, showing a wide variation of survival r ates[3,14,15]. Set our own criteria for implementing ECPR in patients with refractory OHCA based on previous studies and assessed the differences in good neurologic outcome and survival rates before and after application of the criteria

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