by Daniel Rob, Jana
Smalcova, Ondrej Smid, Ales Kral, Tomas Kovarnik, David Zemanek, Petra Kavalkova,
Michal Huptych, Arnost Komarek, Ondrej Franek, Stepan Havranek, Ales Linhart
and Jan Belohlavek
Critical Care volume 26,
Article number: 330 (2022)
Background
Survival rates in refractory out-of-hospital cardiac arrest
(OHCA) remain low with conventional advanced cardiac life support (ACLS).
Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a
method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase
survival. This study examined whether ECPR is associated with improved
outcomes.
Methods
Prague OHCA trial enrolled adults with a witnessed
refractory OHCA of presumed cardiac origin. In this secondary analysis, the
effect of ECPR on 180-day survival using Kaplan–Meier estimates and Cox
proportional hazard model was examined.
Results
Among 256 patients (median age 58 years, 83% male) with
median duration of resuscitation 52.5 min (36.5–68), 83 (32%) patients
achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81
(32%) patients did not achieve prehospital ROSC with prolonged conventional
ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR.
The overall 180-day survival was 51/83 (61.5%) in patients with prehospital
ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with
conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC
treated with ECPR (log-rank p < 0.001). After adjustment for covariates
(age, sex, initial rhythm, prehospital ROSC status, time of emergency medical
service arrival, resuscitation time, place of cardiac arrest, percutaneous
coronary intervention status), ECPR was associated with a lower risk of 180-day
death (HR 0.21, 95% CI 0.14–0.31; P < 0.001).
Conclusions
In this secondary analysis of the randomized refractory OHCA
trial, ECPR was associated with improved 180-day survival in patients without
prehospital ROSC.
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