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Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study
- 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.
- Subjects :
- medicine.medical_specialty
education.field_of_study
Resuscitation
business.industry
medicine.medical_treatment
Population
030208 emergency & critical care medicine
Odds ratio
030204 cardiovascular system & hematology
Return of spontaneous circulation
Sudden death
03 medical and health sciences
0302 clinical medicine
Emergency medicine
medicine
Extracorporeal membrane oxygenation
Extracorporeal cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Cardiology and Cardiovascular Medicine
education
business
Subjects
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