• Resuscitation · May 2021

    Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest.

    • Guillaume Debaty, Lionel Lamhaut, Romain Aubert, Mathilde Nicol, Caroline Sanchez, Olivier Chavanon, Pierre Bouzat, Michel Durand, Gérald Vanzetto, Alice Hutin, Deborah Jaeger, Tahar Chouihed, and José Labarère.
    • University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Department of Emergency Medicine, Grenoble Alpes University Hospital, Grenoble, France. Electronic address: gdebaty@gmail.com.
    • Resuscitation. 2021 May 1; 162: 163-170.

    PurposePrognostication of refractory out-of-hospital cardiac arrest (OHCA) is essential for selecting the population that may benefit from extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to examine the prognostic value of signs of life before or throughout conventional CPR for individuals undergoing ECPR for refractory OHCA.MethodsPooling the original data from three cohort studies, we estimated the prevalence of signs of life, for individuals with refractory OHCA resuscitated with ECPR. We performed multivariable logistic regression to examine the independent associations between the occurrence of signs of life and 30-day survival with a CPC score ≤ 2.ResultsThe analytical sample consisted of 434 ECPR recipients. The prevalence of any sign of life was 61%, including pupillary light reaction (48%), gasping (32%), or increased level of consciousness (13%). Thirty-day survival with favorable neurological outcome was 15% (63/434). In multivariable analysis, the adjusted odds ratios of 30-day survival with favorable neurological outcome were 7.35 (95% confidence interval [CI], 2.71-19.97), 5.86 (95% CI, 2.28-15.06), 4.79 (95% CI, 2.16-10.63), and 1.75 (95% CI, 0.95-3.21) for any sign of life, pupillary light reaction, increased level of consciousness, and gasping, respectively.ConclusionThe assessment of signs of life before or throughout CPR substantially improves the accuracy of a multivariable prognostic model in predicting 30-day survival with favorable neurological outcome. The lack of any sign of life might obviate the provision of ECPR for patients without shockable cardiac rhythm.Copyright © 2021 Elsevier B.V. All rights reserved.

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