Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study

Sivagowry Rasalingam Mørk, Carsten Stengaard, Louise Linde, Jacob Eifer Møller, Jo Bønding Andreasen, Helle Laugesen, Sisse Thomassen, Phillip Freeman, Steffen Christensen, Mariann Tang, Emilie Gregers, Jesper Kjaergaard, Christian Hassager, Hans Eiskjær, Christian Juhl Terkelsen

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisKonferenceabstrakt i tidsskriftForskningpeer review

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has
shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking.
Purpose: To describe the survival, neurological outcome, and adherence
to the national consensus with respect to use of ECPR for OHCA, and to
identify factors associated with outcome.
Methods: Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality.
Results: A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital lowflow <100 minutes, pH >6.8 and lactate <15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH <6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels >15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated
with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of
life (45% versus 13%, p<0.001)
Conclusion: A high survival rate with a good neurological outcome was
observed in this population of patients treated with ECPR for OHCA. Signs
of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.
OriginalsprogEngelsk
Artikelnummerehab724.1500
TidsskriftEuropean Heart Journal Supplements
Vol/bind42
NummerSupplement_1
ISSN1554-2815
DOI
StatusUdgivet - 14 okt. 2021
BegivenhedEuropean Society of Cardiology Congress (ESC) 2021 -
Varighed: 27 aug. 202130 aug. 2021

Konference

KonferenceEuropean Society of Cardiology Congress (ESC) 2021
Periode27/08/202130/08/2021

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