Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan
Authors: Inoue Akihiko , Hifumi Toru , Sakamoto Tetsuya , Okamoto Hiroshi , Kunikata Jun , Yokoi Hideto , Sawano Hirotaka , Egawa Yuko , Kato Shunichi , Sugiyama Kazuhiro , Bunya Naofumi , Kasai Takehiko , Ijuin Shinichi , Nakayama Shinichi , Kanda Jun , Kanou Seiya , Takiguchi Toru , Yokobori Shoji , Takada Hiroaki , Inoue Kazushige , Takeuchi Ichiro , Honzawa Hiroshi , Kobayashi Makoto , Hamagami Tomohiro , Takayama Wataru , Otomo Yasuhiro , Maekawa Kunihiko , Shimizu Takafumi , Nara Satoshi , Nasu Michitaka , Takahashi Kuniko , Hagiwara Yoshihiro , Kushimoto Shigeki , Fukuda Reo , Ogura Takayuki , Shiraishi Shin-ichiro , Zushi Ryosuke , Otani Norio , Kikuchi Migaku , Watanabe Kazuhiro , Nakagami Takuo , Shoko Tomohisa , Kitamura Nobuya , Otani Takayuki , Matsuoka Yoshinori , Aoki Makoto , Sakuraya Masaaki , Arimoto Hideki , Homma Koichiro , Naito Hiromichi , Nakao Shunichiro , Okazaki Tomoya , Tahara Yoshio , Kuroda Yasuhiro ,   the SAVE-J II study group, Senda Asae , Suzuki Hajime , Tanimoto Atsunori , Kitagawa Kanta , Katayama Yoichi , Igarashi Nobuaki , Kawano Masayuki , Kuroki Yuji , Umehara Tadashi , Sasaki Yukari , Tominaga Naoki , Hamaguchi Takuro , Sakai Takuma , Abe Takeru , Hanafusa Hiroaki , Yamaoka Yuki , Kakizaki Yumi , Sakato Shinya , Kashiwabara Shiho , Kadoya Takashi , Misumi Kayo , Kobayashi Takaomi , Yamada Sou , Kobayashi Masakazu , Akashi Naoko , Kuno Masamune , Maruyama Jun , Kobata Hitoshi , Soh Mitsuhito , Shirasaki Kasumi , Shiba Daiki , Isokawa Shutaro , Uchida Masatoshi , Sakurai Atsushi , Tatsukawa Hirotaka , Nishikawa Marie , Kojima Mitsuaki , Kosaki Ryohei , Shimazui Takashi , Kinoshita Hiroki , Sawada Yusuke , Yamamoto Ryo , Masuzawa Yuya , Matsumura Kazuki , Shimazaki Junya 
Published: May 2022

Background

The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications.

Methods

We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2.

Results

A total of 1644 patients with OHCA were included in this study. The patient age was 18–93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45–66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively.

Conclusions

In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.