Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study
Authors: Bougouin Wulfran , Dumas Florence , Lamhaut Lionel , Marijon Eloi , Carli Pierre , Combes Alain , Pirracchio Romain , Aissaoui Nadia , Karam Nicole , Deye Nicolas , Sideris Georgios , Beganton Frankie , Jost Daniel , Cariou Alain , Jouven Xavier ,   the Sudden Death Expertise Center investigators, Adnet F , Agostinucci J M , Aissaoui-Balanant N , Algalarrondo V , Alla F , Alonso C , Amara W , Annane D , Antoine C , Aubry P , Azoulay E , Beganton F , Benhamou D , Billon C , Bougouin W , Boutet J , Bruel C , Bruneval P , Cariou A , Carli P , Casalino E , Cerf C , Chaib A , Cholley B , Cohen Y , Combes A , Crahes M , Da Silva D , Das V , Demoule A , Denjoy I , Deye N , Dhonneur G , Diehl J L , Dinanian S , Domanski L , Dreyfuss D , Duboc D , Dubois-Rande J L , Dumas F , Empana J P , Extramiana F , Fartoukh M , Fieux F , Gabbas M , Gandjbakhch E , Geri G , Guidet B , Halimi F , Henry P , Hidden Lucet F , Jabre P , Jacob L , Joseph L , Jost D , Jouven X , Karam N , Kassim H , Lacotte J , Lahlou-Laforet K , Lamhaut L , Lanceleur A , Langeron O , Lavergne T , Lecarpentier E , Leenhardt A , Lellouche N , Lemiale V , Lemoine F , Linval F , Loeb T , Ludes B , Luyt C E , Maltret A , Mansencal N , Mansouri N , Marijon E , Marty J , Maury E , Maxime V , Megarbane B , Mekontso-Dessap A , Mentec H , Mira J P , Monnet X , Narayanan K , Ngoyi N , Perier M C , Piot O , Pirracchio R , Plaisance P , Plu I , Raux M , Revaux F , Ricard J D , Richard C , Riou B , Roussin F , Santoli F , Schortgen F , Sharifzadehgan A , Sideris G , Spaulding C , Teboul J L , Timsit J F , Tourtier J P , Tuppin P , Ursat C , Varenne O , Vieillard-Baron A , Voicu S , Wahbi K , Waldmann V 
Published: October 2019

Abstract

Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.

Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).

Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.