Toru Hifumi, n/a
MD, PhD
St. Luke’s International Hospital, Japan
Disclosure information not submitted.
Tetsuya Sakamoto
Professor, MD, PhD
Teikyo University Hospital, Japan
Disclosure information not submitted.
Yasuhiro Kuroda, n/a
Professor, MD, PhD
Kagawa University Hospital, Japan
Disclosure information not submitted.
Title: ECPR for Out-of-Hospital Cardiac Arrest Patients: A Retrospective Multicenter Study in Japan
Introduction: Several observational extracorporeal cardiopulmonary resuscitation (ECPR) studies with clinical data have been published; however, those studies have the great limitations with relatively small numbers, and the real-world data of ECPR in out-of-hospital cardiac arrest (OHCA) patients is lacking. In Japan, we have conducted the first prospective multicenter observational study to evaluate the effectiveness of ECPR and conventional cardiopulmonary resuscitation for OHCA patients with initial shockable rhythm (i.e., SAVE-J study). Next, our group planned the retrospective large cohort study named SAVE-J II study to provide real-world data on ECPR in Japan including details of clinical data with approximately 2,000 patients. This study aimed to assess patient characteristics, outcomes, and complications of ECPR practice in patients with OHCA.
Methods: Retrospective database analysis of observational cohorts of OHCA patients with presumed cardiac etiology undergoing ECPR before ICU admission from 2013 to 2018 was performed. Patients who archived return of spontaneous circulation (ROSC) at hospital arrival, and ROSC at the veno-arterial extracorporeal membrane oxygenation initiation (VA ECMO) were excluded. The primary outcome was favorable neurological outcome at hospital discharge, defined as the cerebral performance categories of 1–2. Survival to hospital discharge and complications were secondary outcomes.
Results: Of the 2,157 OHCA patients treated with ECPR enrolled in the SAVE-J II study, 1,463 were included. The patient age ranged from 18 to 90 years (median, 60 years). The initial cardiac rhythm at the scene of shockable rhythm was 73.3%. Time from call ambulance to ECMO was 56 (47–67) [medians (interquartile range) min]. Favorable neurological outcome at hospital discharge was observed in 13.3%, and patients with 26.5% of survived at hospital discharge. Favorable neurological outcomes by initial cardiac rhythm at the scene were 15.3% for shockable, 9.4% for PEA, and 4.1% for asystole. The most common complication was bleeding, and cannulation related bleeding and other hemorrhage were observed in 16.1% and 8.3%, respectively.
Conclusions: The current ECPR data including 1,463 OHCA patients showed 13.3% of favorable neurological outcomes at hospital discharge in unselected OHCA patients.