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Early Extracorporeal CPR for Out-of-Hospital Cardiac Arrest
Quick Takes
- This study of out-of-hospital cardiac arrest patients with ventricular arrhythmia presentation and no return of spontaneous circulation within 15 minutes compared conventional CPR to extracorporeal CPR, and it found no significant difference in the rate of survival with a favorable neurologic outcome.
- Benefits of extracorporeal CPR may have been attenuated by better-than-expected survival in the control arm of the study.
Study Questions:
What is the effect of extracorporeal cardiopulmonary resuscitation (CPR) on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest?
Methods:
This was a multicenter, randomized, controlled trial. Patients with an out-of-hospital cardiac arrest received extracorporeal CPR or conventional CPR. Eligible patients had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome at 30 days.
Results:
Among 160 patients who underwent randomization, 70 were assigned to extracorporeal CPR and 64 to conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional CPR group (p = 0.52). The number of serious adverse events per patient was similar in the two groups.
Conclusions:
The authors concluded that in patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome.
Perspective:
The present study addressed the important question of whether extracorporeal CPR (CPR, intra-arrest transport to a hospital followed by extracorporeal membrane oxygenation) provides a greater opportunity of survival with favorable neurologic outcome over conventional CPR in patients presenting with a ventricular arrhythmia arrest and lack of spontaneous return of circulation within 15 minutes. Two prior studies comparing the two strategies were terminated early due to the demonstration of superiority in one (ARREST) and futility in the other (Prague OHCA). Both were single-center studies and had varying methodologies. The present multicenter study failed to show a significant difference between extracorporeal CPR and conventional CPR. Benefits of extracorporeal CPR may have been attenuated by better-than-expected survival in the control arm of the study.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Critical Care, Extracorporeal Circulation, Heart Arrest, Out-of-Hospital Cardiac Arrest, Secondary Prevention, Survival
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