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

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DOI

  • Sivagowry Rasalingam Mørk
  • Carsten Stengaard
  • Louise Linde, Syddansk Universitet
  • ,
  • Jacob Eifer Møller, From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
  • ,
  • Lisette Okkels Jensen, Syddansk Universitet
  • ,
  • Henrik Schmidt, Syddansk Universitet
  • ,
  • Lars Peter Riber, Syddansk Universitet
  • ,
  • Jo Bønding Andreasen, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Sisse Anette Thomassen, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Helle Laugesen, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Phillip Michael Freeman, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Steffen Christensen
  • Jacob Raben Greisen
  • ,
  • Mariann Tang
  • Peter Hasse Møller-Sørensen, Københavns Universitet
  • ,
  • Lene Holmvang, Københavns Universitet
  • ,
  • Emilie Gregers, Københavns Universitet
  • ,
  • Jesper Kjaergaard, Københavns Universitet
  • ,
  • Christian Hassager, Københavns Universitet
  • ,
  • Hans Eiskjær
  • Christian Juhl Terkelsen

BACKGROUND: Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome.

METHODS: This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan-Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality.

RESULTS: A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow-Pittsburgh Cerebral Performance Categories 1-2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, 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 asystole (RR 1.36, 95% CI 1.18-1.57), pulseless electrical activity (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 reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52-0.76).

CONCLUSIONS: A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

OriginalsprogEngelsk
Artikelnummer174
TidsskriftCritical Care
Vol/bind25
Nummer1
ISSN1466-609X
DOI
StatusUdgivet - maj 2021

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