Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest

A prospective observational study

Tetsuya Sakamoto, Naoto Morimura, Ken Nagao, Yasufumi Asai, Hiroyuki Yokota, Satoshi Nara, Mamoru Hase, Yoshio Tahara, Takahiro Atsumi, Nobuaki Kokubu, Ken Kozuma, Reo Fukuda, Takahiro Ueda, Tadayoshi Miyagi, Isao Takahashi, Mineji Hayakawa, Tomoyuki Endo, Ryouichi Tosa, Takashi Tagami, Taro Mizutani & 80 others Susumu Yasuda, Masaki Ano, Takashi Ogino, Kazuya Kiyota, Kazuyuki Ono, Migaku Kikuchi, Hisao Matsushima, Kitamura Shinya, Shunsuke Otani, Kazuhiro Watanabe, Harumi Hirose, Katsunori Sasaki, Yasuhiro Otomo, Yutaka Seki, Makiko Osawa, Munekazu Takeda, Arino Yaguchi, Kentarou Morikawa, Yasufumi Miyake, Masamune Kuno, Katsuhisa Tanjoh, Kosaku Kinoshita, Takao Arai, Kenichirou Kumasaka, Shingo Hori, Masaru Suzuki, Manabu Sugita, Hirokazu Okubo, Jun Sasaki, Yukihiro Watoh, Kiyoshi Matsuda, Tat Suho Kobayashi, Shinji Ogura, Hiroaki Ushikoshi, Shinsuke Ojio, Minoru Maeda, Masahiko Uzura, Hiroaki Higashioka, Terutake Yonemori, Tomonori Hattori, Yoshimi Kitagawa, Shigeki Tsuboi, Hirotaka Tatsukawa, Hirotaka Sawano, Hideki Arimoto, Yasunori Ueda, Kazunori Kashiwase, Minoru Ukikusa, Toshiaki Hamasaki, Shuichi Kozawa, Nobuaki Igarashi, Junya Sato, Noboru Ishii, Akira Takahashi, Kazunari Toyama, Joji Kotani, Masaharu Ishi-hara, Takayuki Otani, Shunji Kasaoka, Makoto Suzuki, Yusuke Yamamoto, Kumpei Osaka, Masaharu Yagi, Shuichi Kobashi, Naoki Momose, Hiroyuki Noguchi, Satoshi Tamashiro, Yoshinori Taka-hashi, Osamu Okawa, Toru Matayoshi, Takahiro Miki, Naoki Kurashima, Ken Magata, Koji Sugawara, Takanori Oshiyama, Keiichi Tojo, Tomio Koyama, Teruyuki Hayashi, Junji Ohhira, Yasuyuki Araki

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.

Original languageEnglish
Pages (from-to)762-768
Number of pages7
JournalResuscitation
Volume85
Issue number6
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Observational Studies
Prospective Studies
Ventricular Fibrillation
Ventricular Tachycardia
Cerebrovascular Circulation
Electrocardiography
Induced Hypothermia
Intention to Treat Analysis
Recovery of Function

Keywords

  • Advanced life support
  • Cardiopulmonary resuscitation
  • Extracorporeal cardiopulmonary resuscitation
  • Out-of-hospital cardiac arrest
  • Percutaneous cardiopulmonary support
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine
  • Medicine(all)

Cite this

Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest : A prospective observational study. / Sakamoto, Tetsuya; Morimura, Naoto; Nagao, Ken; Asai, Yasufumi; Yokota, Hiroyuki; Nara, Satoshi; Hase, Mamoru; Tahara, Yoshio; Atsumi, Takahiro; Kokubu, Nobuaki; Kozuma, Ken; Fukuda, Reo; Ueda, Takahiro; Miyagi, Tadayoshi; Takahashi, Isao; Hayakawa, Mineji; Endo, Tomoyuki; Tosa, Ryouichi; Tagami, Takashi; Mizutani, Taro; Yasuda, Susumu; Ano, Masaki; Ogino, Takashi; Kiyota, Kazuya; Ono, Kazuyuki; Kikuchi, Migaku; Matsushima, Hisao; Shinya, Kitamura; Otani, Shunsuke; Watanabe, Kazuhiro; Hirose, Harumi; Sasaki, Katsunori; Otomo, Yasuhiro; Seki, Yutaka; Osawa, Makiko; Takeda, Munekazu; Yaguchi, Arino; Morikawa, Kentarou; Miyake, Yasufumi; Kuno, Masamune; Tanjoh, Katsuhisa; Kinoshita, Kosaku; Arai, Takao; Kumasaka, Kenichirou; Hori, Shingo; Suzuki, Masaru; Sugita, Manabu; Okubo, Hirokazu; Sasaki, Jun; Watoh, Yukihiro; Matsuda, Kiyoshi; Kobayashi, Tat Suho; Ogura, Shinji; Ushikoshi, Hiroaki; Ojio, Shinsuke; Maeda, Minoru; Uzura, Masahiko; Higashioka, Hiroaki; Yonemori, Terutake; Hattori, Tomonori; Kitagawa, Yoshimi; Tsuboi, Shigeki; Tatsukawa, Hirotaka; Sawano, Hirotaka; Arimoto, Hideki; Ueda, Yasunori; Kashiwase, Kazunori; Ukikusa, Minoru; Hamasaki, Toshiaki; Kozawa, Shuichi; Igarashi, Nobuaki; Sato, Junya; Ishii, Noboru; Takahashi, Akira; Toyama, Kazunari; Kotani, Joji; Ishi-hara, Masaharu; Otani, Takayuki; Kasaoka, Shunji; Suzuki, Makoto; Yamamoto, Yusuke; Osaka, Kumpei; Yagi, Masaharu; Kobashi, Shuichi; Momose, Naoki; Noguchi, Hiroyuki; Tamashiro, Satoshi; Taka-hashi, Yoshinori; Okawa, Osamu; Matayoshi, Toru; Miki, Takahiro; Kurashima, Naoki; Magata, Ken; Sugawara, Koji; Oshiyama, Takanori; Tojo, Keiichi; Koyama, Tomio; Hayashi, Teruyuki; Ohhira, Junji; Araki, Yasuyuki.

In: Resuscitation, Vol. 85, No. 6, 2014, p. 762-768.

Research output: Contribution to journalArticle

Sakamoto, T, Morimura, N, Nagao, K, Asai, Y, Yokota, H, Nara, S, Hase, M, Tahara, Y, Atsumi, T, Kokubu, N, Kozuma, K, Fukuda, R, Ueda, T, Miyagi, T, Takahashi, I, Hayakawa, M, Endo, T, Tosa, R, Tagami, T, Mizutani, T, Yasuda, S, Ano, M, Ogino, T, Kiyota, K, Ono, K, Kikuchi, M, Matsushima, H, Shinya, K, Otani, S, Watanabe, K, Hirose, H, Sasaki, K, Otomo, Y, Seki, Y, Osawa, M, Takeda, M, Yaguchi, A, Morikawa, K, Miyake, Y, Kuno, M, Tanjoh, K, Kinoshita, K, Arai, T, Kumasaka, K, Hori, S, Suzuki, M, Sugita, M, Okubo, H, Sasaki, J, Watoh, Y, Matsuda, K, Kobayashi, TS, Ogura, S, Ushikoshi, H, Ojio, S, Maeda, M, Uzura, M, Higashioka, H, Yonemori, T, Hattori, T, Kitagawa, Y, Tsuboi, S, Tatsukawa, H, Sawano, H, Arimoto, H, Ueda, Y, Kashiwase, K, Ukikusa, M, Hamasaki, T, Kozawa, S, Igarashi, N, Sato, J, Ishii, N, Takahashi, A, Toyama, K, Kotani, J, Ishi-hara, M, Otani, T, Kasaoka, S, Suzuki, M, Yamamoto, Y, Osaka, K, Yagi, M, Kobashi, S, Momose, N, Noguchi, H, Tamashiro, S, Taka-hashi, Y, Okawa, O, Matayoshi, T, Miki, T, Kurashima, N, Magata, K, Sugawara, K, Oshiyama, T, Tojo, K, Koyama, T, Hayashi, T, Ohhira, J & Araki, Y 2014, 'Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study', Resuscitation, vol. 85, no. 6, pp. 762-768. https://doi.org/10.1016/j.resuscitation.2014.01.031
Sakamoto, Tetsuya ; Morimura, Naoto ; Nagao, Ken ; Asai, Yasufumi ; Yokota, Hiroyuki ; Nara, Satoshi ; Hase, Mamoru ; Tahara, Yoshio ; Atsumi, Takahiro ; Kokubu, Nobuaki ; Kozuma, Ken ; Fukuda, Reo ; Ueda, Takahiro ; Miyagi, Tadayoshi ; Takahashi, Isao ; Hayakawa, Mineji ; Endo, Tomoyuki ; Tosa, Ryouichi ; Tagami, Takashi ; Mizutani, Taro ; Yasuda, Susumu ; Ano, Masaki ; Ogino, Takashi ; Kiyota, Kazuya ; Ono, Kazuyuki ; Kikuchi, Migaku ; Matsushima, Hisao ; Shinya, Kitamura ; Otani, Shunsuke ; Watanabe, Kazuhiro ; Hirose, Harumi ; Sasaki, Katsunori ; Otomo, Yasuhiro ; Seki, Yutaka ; Osawa, Makiko ; Takeda, Munekazu ; Yaguchi, Arino ; Morikawa, Kentarou ; Miyake, Yasufumi ; Kuno, Masamune ; Tanjoh, Katsuhisa ; Kinoshita, Kosaku ; Arai, Takao ; Kumasaka, Kenichirou ; Hori, Shingo ; Suzuki, Masaru ; Sugita, Manabu ; Okubo, Hirokazu ; Sasaki, Jun ; Watoh, Yukihiro ; Matsuda, Kiyoshi ; Kobayashi, Tat Suho ; Ogura, Shinji ; Ushikoshi, Hiroaki ; Ojio, Shinsuke ; Maeda, Minoru ; Uzura, Masahiko ; Higashioka, Hiroaki ; Yonemori, Terutake ; Hattori, Tomonori ; Kitagawa, Yoshimi ; Tsuboi, Shigeki ; Tatsukawa, Hirotaka ; Sawano, Hirotaka ; Arimoto, Hideki ; Ueda, Yasunori ; Kashiwase, Kazunori ; Ukikusa, Minoru ; Hamasaki, Toshiaki ; Kozawa, Shuichi ; Igarashi, Nobuaki ; Sato, Junya ; Ishii, Noboru ; Takahashi, Akira ; Toyama, Kazunari ; Kotani, Joji ; Ishi-hara, Masaharu ; Otani, Takayuki ; Kasaoka, Shunji ; Suzuki, Makoto ; Yamamoto, Yusuke ; Osaka, Kumpei ; Yagi, Masaharu ; Kobashi, Shuichi ; Momose, Naoki ; Noguchi, Hiroyuki ; Tamashiro, Satoshi ; Taka-hashi, Yoshinori ; Okawa, Osamu ; Matayoshi, Toru ; Miki, Takahiro ; Kurashima, Naoki ; Magata, Ken ; Sugawara, Koji ; Oshiyama, Takanori ; Tojo, Keiichi ; Koyama, Tomio ; Hayashi, Teruyuki ; Ohhira, Junji ; Araki, Yasuyuki. / Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest : A prospective observational study. In: Resuscitation. 2014 ; Vol. 85, No. 6. pp. 762-768.
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abstract = "Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3{\%} (32/260) in the ECPR group and 1.5{\%} (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2{\%} (29/260) and 2.6{\%} (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7{\%} (32/234) in the ECPR group and 1.9{\%} (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4{\%} (29/234) and 3.1{\%} (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.",
keywords = "Advanced life support, Cardiopulmonary resuscitation, Extracorporeal cardiopulmonary resuscitation, Out-of-hospital cardiac arrest, Percutaneous cardiopulmonary support, Ventricular fibrillation",
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TY - JOUR

T1 - Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest

T2 - A prospective observational study

AU - Sakamoto, Tetsuya

AU - Morimura, Naoto

AU - Nagao, Ken

AU - Asai, Yasufumi

AU - Yokota, Hiroyuki

AU - Nara, Satoshi

AU - Hase, Mamoru

AU - Tahara, Yoshio

AU - Atsumi, Takahiro

AU - Kokubu, Nobuaki

AU - Kozuma, Ken

AU - Fukuda, Reo

AU - Ueda, Takahiro

AU - Miyagi, Tadayoshi

AU - Takahashi, Isao

AU - Hayakawa, Mineji

AU - Endo, Tomoyuki

AU - Tosa, Ryouichi

AU - Tagami, Takashi

AU - Mizutani, Taro

AU - Yasuda, Susumu

AU - Ano, Masaki

AU - Ogino, Takashi

AU - Kiyota, Kazuya

AU - Ono, Kazuyuki

AU - Kikuchi, Migaku

AU - Matsushima, Hisao

AU - Shinya, Kitamura

AU - Otani, Shunsuke

AU - Watanabe, Kazuhiro

AU - Hirose, Harumi

AU - Sasaki, Katsunori

AU - Otomo, Yasuhiro

AU - Seki, Yutaka

AU - Osawa, Makiko

AU - Takeda, Munekazu

AU - Yaguchi, Arino

AU - Morikawa, Kentarou

AU - Miyake, Yasufumi

AU - Kuno, Masamune

AU - Tanjoh, Katsuhisa

AU - Kinoshita, Kosaku

AU - Arai, Takao

AU - Kumasaka, Kenichirou

AU - Hori, Shingo

AU - Suzuki, Masaru

AU - Sugita, Manabu

AU - Okubo, Hirokazu

AU - Sasaki, Jun

AU - Watoh, Yukihiro

AU - Matsuda, Kiyoshi

AU - Kobayashi, Tat Suho

AU - Ogura, Shinji

AU - Ushikoshi, Hiroaki

AU - Ojio, Shinsuke

AU - Maeda, Minoru

AU - Uzura, Masahiko

AU - Higashioka, Hiroaki

AU - Yonemori, Terutake

AU - Hattori, Tomonori

AU - Kitagawa, Yoshimi

AU - Tsuboi, Shigeki

AU - Tatsukawa, Hirotaka

AU - Sawano, Hirotaka

AU - Arimoto, Hideki

AU - Ueda, Yasunori

AU - Kashiwase, Kazunori

AU - Ukikusa, Minoru

AU - Hamasaki, Toshiaki

AU - Kozawa, Shuichi

AU - Igarashi, Nobuaki

AU - Sato, Junya

AU - Ishii, Noboru

AU - Takahashi, Akira

AU - Toyama, Kazunari

AU - Kotani, Joji

AU - Ishi-hara, Masaharu

AU - Otani, Takayuki

AU - Kasaoka, Shunji

AU - Suzuki, Makoto

AU - Yamamoto, Yusuke

AU - Osaka, Kumpei

AU - Yagi, Masaharu

AU - Kobashi, Shuichi

AU - Momose, Naoki

AU - Noguchi, Hiroyuki

AU - Tamashiro, Satoshi

AU - Taka-hashi, Yoshinori

AU - Okawa, Osamu

AU - Matayoshi, Toru

AU - Miki, Takahiro

AU - Kurashima, Naoki

AU - Magata, Ken

AU - Sugawara, Koji

AU - Oshiyama, Takanori

AU - Tojo, Keiichi

AU - Koyama, Tomio

AU - Hayashi, Teruyuki

AU - Ohhira, Junji

AU - Araki, Yasuyuki

PY - 2014

Y1 - 2014

N2 - Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.

AB - Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.

KW - Advanced life support

KW - Cardiopulmonary resuscitation

KW - Extracorporeal cardiopulmonary resuscitation

KW - Out-of-hospital cardiac arrest

KW - Percutaneous cardiopulmonary support

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=84901259752&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901259752&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2014.01.031

DO - 10.1016/j.resuscitation.2014.01.031

M3 - Article

VL - 85

SP - 762

EP - 768

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

IS - 6

ER -