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Long-Term Neurological Outcome of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest Patients With Nonshockable Rhythms: A Single-Center, Consecutive, Retrospective Observational Study

      Abstract

      Background

      Data on extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) and initially nonshockable rhythms are limited.

      Objective

      This study aimed to evaluate the long-term neurological outcomes of ECPR for patients with OHCA and initially nonshockable rhythms.

      Methods

      In this single-center, consecutive, retrospective, observational study, patients with OHCA and initially nonshockable rhythms who underwent ECPR between January 2012 and December 2017 were included. All patients with refractory cardiopulmonary arrest were transported while undergoing conventional CPR and received ECPR on arrival in the emergency department. We retrospectively collected characteristics at admission and neurological outcomes at the last visit or telephone interview. Cerebral performance category (CPC) scales 1 and 2 were defined as good neurological outcomes and CPC scales 3, 4, and 5 were defined as poor neurological outcomes.

      Results

      Of the 39 patients included in this study, 32 died in the hospital and only 7 survived. There were 4, 0, 0, 3, and 32 patients with CPC 1, 2, 3, 4, and 5, respectively. The proportion of good neurological outcomes for all patients was 10.3% (95% CI 2.9–24.2%) and 14.3% (95% CI 4.0–32.7%) for patients with pulseless electrical activity. No patients with asystole had a good neurological outcome. Median follow-up period was 1052 days (interquartile range 116–1589 days) for those who survived to discharge.

      Conclusions

      Approximately 10% of initially nonshockable patients with OHCA, generally considered to be a poor prognosis, could acquire good neurological outcomes when they underwent ECPR with our indications.

      Keywords

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      References

        • Kitamura T
        • Iwami T
        • Kawamura T
        • et al.
        Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan.
        Circulation. 2012; 126: 2834-2843
        • Becker L
        • Gold LS
        • Eisenberg M
        • White L
        • Hearne T
        • Rea T
        Ventricular fibrillation in King County, Washington: a 30-year perspective.
        Resuscitation. 2008; 79: 22-27
        • Adielsson A
        • Hollenberg J
        • Karlsson T
        • et al.
        Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. experiences from Sweden in an 18-year perspective.
        Heart. 2011; 97: 1391-1396
        • Bobrow BJ
        • Spaite DW
        • Berg RA
        • et al.
        Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest.
        JAMA. 2010; 304: 1447-1454
        • Andrew E
        • Nehme Z
        • Lijovic M
        • Bernard S
        • Smith K.
        Outcomes following out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity in Victoria, Australia.
        Resuscitation. 2014; 85: 1633-1639
        • Sakamoto T
        • Morimura N
        • Nagao K
        • et al.
        Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.
        Resuscitation. 2014; 85: 762-768
        • Soar J
        • Berg KM
        • Andersen LW
        • et al.
        Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Resuscitation. 2020; 156: A80-119
        • Kanda Y.
        Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Väyrynen T
        • Kuisma M
        • Määttä T
        • Boyd J.
        who survives from out-of-hospital pulseless electrical activity?.
        Resuscitation. 2008; 76: 207-213
        • Goto Y
        • Maeda T
        • Goto Y.
        Decision-tree model for predicting outcomes after out-of-hospital cardiac arrest in the emergency department.
        Crit Care. 2013; 17: R133
        • Shinozaki K
        • Oda S
        • Sadahiro T
        • et al.
        Blood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest.
        Resuscitation. 2011; 82: 404-409
        • Kasai A
        • Nagao K
        • Kikushima K
        • et al.
        Prognostic value of venous blood ammonia in patients with out-of-hospital cardiac arrest.
        Circ J. 2012; 76: 891-899
        • Cho YM
        • Lim YS
        • Yang HJ
        • et al.
        Blood ammonia is a predictive biomarker of neurologic outcome in cardiac arrest patients treated with therapeutic hypothermia.
        Am J Emerg Med. 2012; 30: 1395-1401
        • Javaudin F
        • Leclere B
        • Segard J
        • et al.
        Performance of early absence of pupillary light reaction after recovery of out of hospital cardiac arrest.
        Resuscitation. 2018; 127: 8-13
        • Debaty G
        • Labarere J
        • Frascone RJ
        • et al.
        Long-term prognostic value of gasping during out-of-hospital cardiac arrest.
        J Am Coll Cardiol. 2017; 70: 1467-1476
        • Grunau B
        • Reynolds JC
        • Scheuermeyer FX
        • et al.
        Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: informing minimum durations of resuscitation.
        Resuscitation. 2016; 101: 50-56
        • Reynolds JC
        • Frisch A
        • Rittenberger JC
        • Callaway CW.
        Resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies?.
        Circulation. 2013; 128: 2488-2494