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 MizutaniSusumu 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

211 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 Jun
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    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., ... Araki, Y. (2014). Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study. Resuscitation, 85(6), 762-768. https://doi.org/10.1016/j.resuscitation.2014.01.031