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Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study

Authors :
Nicolas Deye
Eloi Marijon
Nicole Karam
Nadia Aissaoui
Daniel Jost
Lionel Lamhaut
Romain Pirracchio
Pierre Carli
Alain Cariou
Georgios Sideris
Frankie Beganton
Florence Dumas
Alain Combes
Wulfran Bougouin
Xavier Jouven
Source :
European Heart Journal. 41:1961-1971
Publication Year :
2019
Publisher :
Oxford University Press (OUP), 2019.

Abstract

Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. 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 (95% 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 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 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 In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

Details

ISSN :
15229645 and 0195668X
Volume :
41
Database :
OpenAIRE
Journal :
European Heart Journal
Accession number :
edsair.doi...........4c4eee65582e7ce810eea566cb3a9e2e
Full Text :
https://doi.org/10.1093/eurheartj/ehz753