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Extracorporeal CPR in Out-of-Hospital Cardiac Arrest
Study Questions:
What are the outcomes of patients with out-of-hospital cardiac arrest (OHCA) managed with extracorporeal–cardiopulmonary resuscitation (CPR) or conventional-CPR?
Methods:
The investigators analyzed a prospective registry of 13,191 OHCAs in the Paris region from May 2011 to January 2018. They compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. To compare survival to hospital discharge (primary outcome measure) between the groups managed with extracorporeal-CPR and conventional-CPR, multivariable logistic regression was performed after adjustment for factors known to affect OHCA outcomes.
Results:
Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12,666 patients given conventional-CPR (p = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.8–2.1; p = 0.24). By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and return of spontaneous circulation [ROSC]), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; p = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; p = 0.005), transient ROSC before extracorporeal membrane oxygenation (ECMO) (OR, 2.3; 95% CI, 1.1–4.7; p = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; p = 0.002).
Conclusions:
The authors concluded that in a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival.
Perspective:
This population-based registry study reports that extracorporeal-CPR was not associated with improved outcomes compared with conventional-CPR. Current evidence suggests that extracorporeal-CPR might be best reserved for patients with features associated with better extracorporeal-CPR outcomes (i.e., an initial shockable rhythm and transient ROSC). While this study was underpowered to assess the benefit of coronary intervention in this population, the results are in line with prior reports suggesting that coronary reperfusion among patients treated with extracorporeal-CPR could be associated with an improved survival. Finally, the optimal use of extracorporeal-CPR to treat OHCA requires additional study, especially regarding long-term neurological outcome.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and ACS
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation, Heart Arrest, Myocardial Reperfusion, Outcome Assessment, Health Care, Out-of-Hospital Cardiac Arrest, Patient Discharge, Primary Prevention
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