• Toru Takiguchi, Naoki Tominaga, Takuro Hamaguchi, Tomohisa Seki, Jun Nakata, Takeshi Yamamoto, Takashi Tagami, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda, Shoji Yokobori, and SAVE-J II Study Group.
• Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: toru-takiguchi@nms.ac.jp.
• Chest. 2024 Apr 1; 165 (4): 858869858-869.

BackgroundA better understanding of the relative contributions of various factors to patient outcomes is essential for optimal patient selection for extracorporeal CPR (ECPR) therapy for patients with out-of-hospital cardiac arrest (OHCA). However, evidence on the prognostic comparison based on the etiologies of cardiac arrest is limited.Research QuestionWhat is the etiology-based prognosis of patients undergoing ECPR for OHCA?Study Design And MethodsThis retrospective multicenter registry study involved 36 institutions in Japan and included all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. The primary etiology for OHCA was determined retrospectively from all hospital-based data at each institution. We performed a multivariable logistic regression model to determine the association between etiology of cardiac arrest and two outcomes: favorable neurologic outcome and survival at hospital discharge.ResultsWe identified 1,781 eligible patients, of whom 1,405 (78.9%) had cardiac arrest because of cardiac causes. Multivariable logistic regression analysis for favorable neurologic outcome showed that accidental hypothermia (adjusted OR, 5.12; 95% CI, 2.98-8.80; P < .001) was associated with a significantly higher rate of favorable neurologic outcome than cardiac causes. Multivariable logistic regression analysis for survival showed that accidental hypothermia (adjusted OR, 5.19; 95% CI, 3.15-8.56; P < .001) had significantly higher rates of survival than cardiac causes. Acute aortic dissection/aneurysm (adjusted OR, 0.07; 95% CI, 0.02-0.28; P < .001) and primary cerebral disorders (adjusted OR, 0.12; 95% CI, 0.03-0.50; P = .004) had significantly lower rates of survival than cardiac causes.InterpretationIn this retrospective multicenter cohort study, although most patients with OHCA underwent ECPR for cardiac causes, accidental hypothermia was associated with favorable neurologic outcome and survival; in contrast, acute aortic dissection/aneurysm and primary cerebral disorders were associated with nonsurvival compared with cardiac causes.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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