• Yohei Okada, Sho Komukai, Taro Irisawa, Tomoki Yamada, Kazuhisa Yoshiya, Changhwi Park, Tetsuro Nishimura, Takuya Ishibe, Hitoshi Kobata, Takeyuki Kiguchi, Masafumi Kishimoto, Sung-Ho Kim, Yusuke Ito, Taku Sogabe, Takaya Morooka, Haruko Sakamoto, Keitaro Suzuki, Atsunori Onoe, Tasuku Matsuyama, Norihiro Nishioka, Satoshi Matsui, Satoshi Yoshimura, Shunsuke Kimata, Shunsuke Kawai, Yuto Makino, Kosuke Kiyohara, Ling Zha, OngMarcus Eng HockMEHHealth Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore., Taku Iwami, and Tetsuhisa Kitamura.
• Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University, Yoshida-Konoe-Cho, Sakyo, Kyoto, 606-8501, Japan. yokada-kyf@umin.ac.jp.
• Crit Care. 2023 Nov 15; 27 (1): 442442.

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) has been proposed as a rescue therapy for patients with refractory cardiac arrest. This study aimed to evaluate the association between ECPR and clinical outcomes among patients with out-of-hospital cardiac arrest (OHCA) using risk-set matching with a time-dependent propensity score.MethodsThis was a secondary analysis of the JAAM-OHCA registry data, a nationwide multicenter prospective study of patients with OHCA, from June 2014 and December 2019, that included adults (≥ 18 years) with OHCA. Initial cardiac rhythm was classified as shockable and non-shockable. Patients who received ECPR were sequentially matched with the control, within the same time (minutes) based on time-dependent propensity scores calculated from potential confounders. The odds ratios with 95% confidence intervals (CI) for 30-day survival and 30-day favorable neurological outcomes were estimated for ECPR cases using a conditional logistic model.ResultsOf 57,754 patients in the JAAM-OHCA registry, we selected 1826 patients with an initial shockable rhythm (treated with ECPR, n = 913 and control, n = 913) and a cohort of 740 patients with an initial non-shockable rhythm (treated with ECPR, n = 370 and control, n = 370). In these matched cohorts, the odds ratio for 30-day survival in the ECPR group was 1.76 [95%CI 1.38-2.25] for shockable rhythm and 5.37 [95%CI 2.53-11.43] for non-shockable rhythm, compared to controls. For favorable neurological outcomes, the odds ratio in the ECPR group was 1.11 [95%CI 0.82-1.49] for shockable rhythm and 4.25 [95%CI 1.43-12.63] for non-shockable rhythm, compared to controls.ConclusionECPR was associated with increased 30-day survival in patients with OHCA with initial shockable and even non-shockable rhythms. Further research is warranted to investigate the reproducibility of the results and who is the best candidate for ECPR.© 2023. The Author(s).

19 keywords...

hide…