Abstract 475: Association Between Bystander Delay in Activating the Emergency Response System and Outcomes Following Out-Of-Hospital Cardiac Arrest: All-Japan National Utstein Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tomoyoshi Tamura ◽  
Tomohisa SEKI ◽  
Masaru Suzuki ◽  
Junichi Sasaki
Keyword(s):  
Cardiac Arrest ◽  
Emergency Response ◽  
Neurological Outcome ◽  
Epinephrine Administration ◽  
Emergency Response System ◽  
Response System ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: An emphasis on the chain of survival has contributed to improved outcomes of out-of-hospital cardiac arrest (OHCA). Although immediate recognition of cardiac arrest (CA) and activation of the emergency response system are the first links in the chain of survival, their impact on outcomes is unclear. Hypothesis: Delayed time from collapse to activation of the emergency response system (bystander delay) is associated with an unfavorable neurological outcome after adult OHCA. Methods: Data from the prospective, nationwide, population-based All-Japan Utstein Registry of the Fire and Disaster Management Agency between January 1, 2012 and December 31, 2016 were analyzed. Of the 625,916 eligible cases, 164,256 adult, non-traumatic, witnessed OHCA including bystander delay times (age, 79 [IQR, 67-86] years; 60% male) were studied. The primary outcome measure was favorable neurological outcome 1 month after an OHCA, defined as a score of 1 or 2 on the Cerebral Performance Category Scale. Results: The median bystander delay time of 2.0 [1.0-4.0] min was shorter among patients who achieved a favorable outcome as compared to 3.0 [1.0-6.0] min (P < 0.001) for patients with an unfavorable outcome. In multivariable logistic regression analyses, bystander delay had an OR for favorable neurological outcome of 0.94 [95% CI, 0.93-0.97] after adjusting for age, sex, etiology of arrest, first documented rhythm, provision of bystander CPR, use of public access automated external defibrillator, epinephrine administration, time intervals of activation of the emergency response system and hospital arrival, and collapse to initiation of CPR, and regional location. Similarly, bystander delay was independently associated with reduced neurologically favorable survival among patients who received bystander CPR within one minute of collapse (adjusted OR, 0.97 [0.97-0.98]). Conclusions: Bystander delay was independently associated with decreased odds of neurologically favorable survival, even among patients for whom bystander CPR was immediately performed.

Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pavitra Kotini-Shah ◽  
Oksana Pugach ◽  
Ruizhe Chen ◽  
Marina Del Rios ◽  
Kimberly Vellano ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Sex Differences ◽  
Coronary Angiography ◽  
Neurological Outcome ◽  
The United States ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

Abstract 8875: Early Compared to Late Administration of Epinephrine in Adults With Shockable Initial Rhythm Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Shengyuan Luo ◽  
Liwen Gu ◽  
Wanwan Zhang ◽  
Yongshu Zhang ◽  
Wankun Li ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Epinephrine Administration ◽  
Lower Odds ◽  
Subgroup Analyses ◽  
Initial Rhythm ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: The optimal timing of epinephrine administration in shockable initial rhythm out-of-hospital cardiac arrest (OHCA) is unclear. Hypothesis: Early compared to late epinephrine following first electrical defibrillation attempt is associated with better outcomes in shockable initial rhythm OHCA. Methods: We conducted a retrospective study in adults with shockable initial rhythm OHCA from 2011-2015 in North America. We used multivariable logistic regression to assess associations between timing of epinephrine and prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and hospital discharge with favorable neurological outcome (modified Rankin Scale score≤3). We used propensity-score-matching and subgroup analyses to assess robustness of associations. Results: Of 6416 patients, median age was 64 (IQR: 54-74) years, 5136 (80%) were men, 2226 (35%) received epinephrine within four minutes after first defibrillation, 5119 (80%), 1237 (19%), and 996 (16%) had prehospital ROSC, survival to hospital discharge, and favorable neurological outcome at discharge respectively. Adjusted for confounders, we observed lower odds of prehospital ROSC (OR=0.95, 95%CI 0.94-0.96; p<0.001), survival to hospital discharge (OR=0.91, 95%CI 0.89-0.92; p<0.001), and favorable neurological outcomes at discharge (OR=0.92, 95%CI 0.90-0.93; p<0.001) per minute later epinephrine administration. Compared to epinephrine administration within four minutes following first defibrillation attempt, later epinephrine was associated with lower odds of prehospital ROSC (OR=0.58, 95%CI 0.51-0.68; p<0.001), survival to hospital discharge (OR=0.50, 95%CI 0.43-0.58; p<0.001), and favorable neurological outcome at discharge (OR=0.51, 95%CI 0.43-0.59; p<0.001). Associations remained significant in a well-balanced propensity score matched cohort and subgroup analyses by witness status, EMS response time, and total epinephrine dose. Conclusion: In shockable initial rhythm OHCA, early compared to late epinephrine administration following first defibrillation attempt was associated with better odds of prehospital ROSC, survival to hospital discharge, and hospital discharge with favorable neurological outcome.

scholarly journals Survival and neurological recovery after out-of-hospital cardiac arrest

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Jarakovic ◽  
S Bjelica ◽  
M Kovacevic ◽  
M Petrovic ◽  
S Dimic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Study Group ◽  
St Segment Elevation ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health challenge and although rate of intrahospital survival increased over the last 40 years, it still remains poor (from 8,6% in 1976-1999 to 9,9% in 2000-2019). Different studies report that introduction of mild therapeutic hypothermia (TTM) improves survival and neurological outcome in comatose patients after OHCA.  Purpose The aim of this research was to evaluate influence of pre-hospital predictors related to cardiopulmonary resuscitation (CPR), neurological status and ECG changes at admission and early percutaneous coronary intervention (PCI) performed within 24h of admission on intrahospital survival and neurological outcome of OHCA patients. Methods The research was conducted as a retrospective cohort study of data taken from the hospital registry on OHCA from January 2007 until November 2019. The analyzed factors were: bystander CPR, duration of CPR until return of ROSC, initial rhythm, responsiveness upon admission defined as Glasgow Coma Score (GCS)&gt;8, presence of ST segment elevation (STEMI) on electrocardiography (ECG) and early PCI. The favorable neurological outcome was defined as a cerebral performance category scale (CPC)≤2. Results The research included 506 survivors of OHCA. Cardiac arrest was witnessed in 412 (81.4%), bystander CPR was performed in 197 (38.9%), CPR lasted ≤20min in 291 (57.5%), initial rhythm was shockable in 304 (60.1%) of patients. At admission 387 (76.5%) were comatose (GCS &lt; 8) and TTM was introduced in 177 (45.7%) of patients. ECG upon admission showed STEMI in 176 (34.8%) and early PCI was performed in 145 (28.6%) of patients. In-hospital mortality in our study group was 281 (55.5%) and 185 (36.6%) of patients had favorable neurological outcome. Multivariate regression analysis showed that initial shockable rhythm (OR 3.391 [2.310-4.977], p &lt; 0.0005), early PCI (OR 0.368 [0.226-0.599], p &lt; 0.0005), duration of CPR ≤20min (OR 4.249 [2.688-6.718], p &lt; 0.0005) and GCS &gt; 8 (OR 0.194 [0.110-0.343], p &lt; 0.0005) were independent predictors of in-hospital survival. Independent predictors of favorable neurological outcome were: initial shockable rhythm (OR 3.301 [2.002-5.441], p&lt; 0.0005), STEMI on ECG upon admission (OR 0.528 [0.326-0.853], p = 0.009), duration of CPR ≤20min (OR 5.144 [3.090-8.565], p&lt; 0.0005) and GCS &gt; 8 (OR 0.152 [0.088-0.260], p&lt; 0.0005). Introduction of TTM improved both intrahospital survival (54.1% vs. 24.4%; p &lt; 0.0005) and neurological outcome (33.5% vs. 11.6%; p &lt; 0.0005) in patients with initial shockable rhythm. Conclusion In our study group of OHCA patients of any origin, initial shockable rhythm, duration of CPR ≤20min and GCS &gt; 8 at admission influenced both intrahospital survival and favorable neurological outcome. Introduction of TTM significantly improved both survival and neurological outcome in comatose patients with initial shockable rhythm.

Abstract 2012: Relationship Between Adrenaline Concentration and Postresuscitation Syndrome in Patients with Return of Spontaneous Circulation (ROSC) After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kei Nishikawa ◽  
Ken Nagao ◽  
Kimio Kikushima ◽  
Kazuhiro Watanabe ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Epinephrine Administration ◽  
Cutoff Value ◽  
Neurological Outcomes ◽  
A Prospective Study ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background Although there is evidence that epinephrine hydrochloride favors initial ROSC, there is a paucity of evidence that it improves survival in humans. The value and safety of the Î 2 -adrenergic effects of epinephrine is controversial because they may lead to increase postresuscitation syndrome after ROSC. Few studies have investigated whether adrenaline concentration before epinephrine administration was related to incidence of postresuscitation syndrome. METHODS We did a prospective study of adult patients who achieved ROSC with standard cardiopulmonary resuscitation after out-of-hospital cardiac arrest. Blood samples to measure the adrenaline concentration were taken from a vein. The primary endpoint was neurological outcomes at hospital discharge. RESULTS Of the 274 adult patients with out-of-hospital cardiac arrest, 108(39%) achieved ROSC. The adrenaline levels ranged from 53 to 15,329pg/ml, with a median of 1,545pg/ml, and 25th and 75th percentile values of 707 and 4,486pg/ml, respectively. Of those, 71% (77/108) had an unfavorable neurological outcome and the adrenaline level was higher among such patients than among those with a favorable neurological outcome (a median, 2,016pg/ml vs. 938pg/ml, p=0.048). Moreover, the adrenaline level was higher among patients who died of postresuscitation syndrome within 24 hours of ROSC than among those with survival at 24 hours (a median, 3,290pg/ml vs. 1,343pg/ml, p=0.038). The adrenaline cutoff value of 944pg/ml for unfavorable neurological outcome had an accuracy of 70%. The adjusted odds ratio for the unfavorable neurological outcome after adrenaline cutoff value of 944pg/ml was 8.9 (95% CI, 2.2–35.9; p=0.002). On the other hand, the adrenaline level after epinephrine administration was 28 times as high as that before epinephrine administration (a median, 42,868pg/ml vs. 1,545pg/ml, p<0.0001). CONCLUSIONS In adult patients with ROSC after out-of-hospital cardiac arrest, adrenaline level before epinephrine administration was associated with incidence of postresuscitation syndrome, and the level was extremely increased after epinephrine administration. Epinephrine administration may lead to a severe toxic hyperadrenergic state in postresuscitation period.

Abstract 169: Association Between Time to First Administration of Epinephrine After Defibrillation and Outcome in Out-Of-Hospital Cardiac Arrest Patients With Shockable Rhythm

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Shoji Kawakami ◽  
Yoshio Tahara ◽  
Teruo Noguchi ◽  
Satoshi Yasuda ◽  
Naohiro W Yonemoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Population Based ◽  
Emergency Medical Service Personnel ◽  
Epinephrine Administration ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: In out-of-hospital cardiac arrest (OHCA) patients during shockable rhythm, the epinephrine administration after second defibrillation is recommended by the 2015 ILCOR/CoSTR guidelines. However, there is insufficient evidence regarding the proper timing of epinephrine administration particularly in relation to defibrillation. Hypothesis: The timing of epinephrine after first defibrillation (D-E interval) was associated with clinical outcome in OHCA patients. Methods: Between 2011 and 2016, we enrolled 753,025 OHCA patients from nationwide prospective population-based registry in Japan. Following exclusion criteria, a total of 1,559 patients with witnessed by bystanders and shockable rhythm on the initial electrocardiogram who administrated epinephrine after defibrillation by emergency medical service personnel and obtained return of spontaneous circulation in prehospital setting were eligible for the study. We evaluated the association between D-E interval and favorable neurological outcome (cerebral performance category: 1 or 2) at 30 days. To evaluate predictor for better neurological outcome, study patients were categorized as every 2 minutes up to 20 minutes, and more than 20 minutes. Results: Patients with favorable neurological outcome were 22% (N=348). Patients with favorable neurological outcome had a shorter D-E interval than those with non-favorable neurological outcome (7.9±4.1vs 10.2±5.3 min, p<0.001). Multivariate logistic regression analysis showed that D-E interval at more than 10 minutes, when D-E interval at 2 to 3 minutes as defined reference, was a significant predictor for non-favorable neurological outcome ( Table ). Conclusion: Delayed epinephrine administration after first defibrillation (D-E interval >10 minutes) was significantly associated with non-favorable neurological outcome.

Abstract 199: Pulmonary Embolism and Accidental Hypothermia Have a Favorable Outcome in Cardiac Arrest With PEA Treated by ECPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shinichi Ijuin ◽  
Akihiko Inoue ◽  
Nobuaki Igarashi ◽  
Shigenari Matsuyama ◽  
Tetsunori Kawase ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Accidental Hypothermia ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Group B ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

scholarly journals A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA2CLE2

2020 ◽  
Author(s):  
Nilesh Pareek ◽  
Peter Kordis ◽  
Nicholas Beckley-Hoelscher ◽  
Dominic Pimenta ◽  
Spela Tadel Kocjancic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Risk Score ◽  
Neurological Outcome ◽  
Heart Attack ◽  
Primary Outcome ◽  
Cerebral Performance Category ◽  
Epinephrine Administration ◽  
Poor Outcome ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

AimsThe purpose of this study was to develop a practical risk−score to predict poor neurological outcome after out−of−hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre.Methods and ResultsBetween May 2012 and December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multi-variable logistic regression to identify factors independently predictive of the primary outcome in order to derive a risk score. This was externally validated in two independent cohorts comprising 474 patients. The primary outcome was poor neurological function at 6−month follow−up (Cerebral Performance Category 3-−). Seven independent variables for prediction of outcome were identified: Missed (Unwitnessed) arrest, Initial non-shockable rhythm, non-Reactivity of pupils, Age, Changing intra-arrest rhythms, Low pH<;7.20 and Epinephrine administration. From these variables, the MIRA2CLE2 score was developed which had an AUC of 0.90 in the development and 0.85 and 0.89 in the validation cohorts. 3 risk groups of the MIRA2CLE2 were defined − Low risk (≤2−5.6% risk of poor outcome; Intermediate risk (3−4−55.4% of poor outcome) and high risk (≥5−92.3% risk of poor outcome). The risk-score performance was equivalent in a sub-group of patients referred for early angiography and revascularisation where appropriate.ConclusionsThe MIRA2CLE2 score is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission to a Heart Attack Centre.

Abstract 588: Extracorporeal Cardiopulmonary Resuscitation for Induction of Hypothermia in Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ken Nagao ◽  
Kimio Kikushima ◽  
Kazuhiro Watanabe ◽  
Eizo Tachibana ◽  
Takaeo Mukouyama ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Control Group ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hypothermia Group ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Therapeutic hypothermia is beneficial to neurological outcome for comatose survivors after out-of-hospital cardiac arrest. However, there are few data of extracorporeal cardiopulmonary resuscitation (ECPR) for induction of hypothermia for patients with out-of-hospital cardiac arrest. We did a prospective study of ECPR with hypothermia for patients with out-of-hospital cardiac arrest. The criteria for inclusion were an age of 18 to 74 years, a witnessed cardiac arrest, collapse-to-patient’s-side interval <15 minutes, cardiac arrest due to presumed cardiac etiology, and persistent cardiac arrest on ER arrival in spite of the prehospital defibrillations. After arrival at the emergency room, cardiopulmonary bypass plus intra-aortic balloon pumping was immediately performed, and then coronary reperfusion therapy during cardiac arrest was added if needed. Mild hypothermia (34°C for 3 days) was immediately induced during cardiac arrest or after return of spontaneous circulation. We selected suitable patients who received conventional CPR with normothermia among a prospective multi-center observational study of patients who had out-of-hospital cardiac arrest in Kanto region of Japan “the SOS-KANTO study” for the control group. The primary endpoint was favorable neurological outcome at the time of hospital discharge. A total of 558 patients were enrolled; 127 received ECPR with hypothermia and 431 received conventional CPR with normothermia. The ECPR with hypothermia group had significantly higher frequency of the favorable neurological outcome than the conventional CPR with normothermia group (12% vs. 2%, unadjusted odds ratio, 8.1; 95% CI; 3.2 to 20.0). The adjusted odds ratio for the favorable neurological outcome after ECPR with hypothermia was 7.4 (95% CI; 2.8 to 19.3, p<0.0001). Among the ECPR with hypothermia group, early attainment of a target core temperature of 34°C increased its efficacy (adjusted odds ratio, 0.99; 95% CI; 0.98 to 1.00, p=0.04). ECPR with hypothermia improved the chance of neurologically intact survival for adult patients with out-of-hospital cardiac arrest, and the early attainment of a target temperature enhanced its efficacy.

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