Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Cardiopulmonary Resuscitation | Research

Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study

Authors: Daniel Patricio, Lorenzo Peluso, Alexandre Brasseur, Olivier Lheureux, Mirko Belliato, Jean-Louis Vincent, Jacques Creteur, Fabio Silvio Taccone

Published in: Critical Care | Issue 1/2019

Login to get access

Abstract

Background

The potential benefit of extracorporeal cardiopulmonary resuscitation (ECPR) compared to conventional CPR (CCPR) for patients with refractory cardiac arrest (CA) remains unclear.

Methods

This study is a retrospective analysis of a prospective database of CA patients, which includes all consecutive adult patients admitted to the Department of Intensive Care after CA between January 2012 and December 2017. The decision to initiate ECPR was made by the attending physician and ECPR performed by the ECPR team, which is composed of ICU physicians. A propensity score was derived using a logistic regression model, including characteristics that varied between groups with a p <  0.10 and were potentially related to outcome. Primary outcomes were survival to ICU discharge and favorable 3-month neurologic outcome, assessed by a Cerebral Performance Category (CPC) score of 1–2.

Results

From a total of 635 patients with CA during the study period (ECPR, n = 112), 80 ECPR patients were matched to 80 CCPR patients. The time from arrest to termination of CPR (i.e., return of spontaneous circulation [ROSC], extracorporeal membrane oxygenation [ECMO] initiation, or death) was 54 ± 22 and 54 ± 19 min in the ECPR and CCPR groups, respectively. ROSC rates were 77/80 (96%) for ECPR and 30/80 (38%) for CCPR (p <  0.001). Survival to ICU discharge was 18/80 (23%) vs. 14/80 (18%) in the ECPR and CCPR groups, respectively (p = 0.42). At 3 months, 17/80 (21%) ECPR patients and 9/80 (11%) CCPR patients had a favorable outcome (p = 0.11). Cox regression analysis stratified by matched pairs showed a significantly higher neurologic outcome rate in the ECPR group than in the CCPR group (log-rank test p = 0.003).

Conclusions

ECPR after CA may be associated with improved long-term neurological outcome.
Literature
1.
Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015. Resuscitation. 2015;95:81–99.CrossRef
2.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346(8):557–63.CrossRef
3.
Kim SJ, Kim HJ, Lee HY, Ahn HS, Lee SW. Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: a meta-analysis. Resuscitation. 2016;103:106–16.CrossRef
4.
Mosca MS, Narotsky DL, Mochari-Greenberger H, Liao M, Mongero L, Beck J, et al. Duration of conventional cardiopulmonary resuscitation prior to extracorporeal cardiopulmonary resuscitation and survival among adult cardiac arrest patients. Perfusion. 2016;31(3):200–6.CrossRef
5.
Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2014;85(6):762–8.CrossRef
6.
Kuroki N, Abe D, Iwama T, Suzuki K, Sugiyama K, Akashi A, Hamabe Y, Aonuma K, Sato A. Association between delay to coronary reperfusion and outcome in patients with acute coronary syndrome undergoing extracorporeal cardiopulmonary resuscitation. Resuscitation. 2017;114:1–6.CrossRef
7.
Dennis M, McCanny P, D’Souza M, Forrest P, Burns B, Lowe DA, et al. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a multicentre experience. Int J Cardiol. 2017;231:131–6.CrossRef
8.
Fagnoul D, Taccone FS, Belhaj A, Rondelet B, Argacha JF, Vincent JL, De Backer D. Extracorporeal life support associated with hypothermia and normoxemia in refractory cardiac arrest. Resuscitation. 2013;84(11):1519–24.CrossRef
9.
Thuong M, Ruiz A, Evrard P, Kuiper M, Boffa C, Akhtar MZ, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016;29(7):749–59.CrossRef
10.
Maekawa K, Tanno K, Hase M, Mori K, Asai Y. Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis. Crit Care Med. 2013;41(5):1186–1196.10.CrossRef
11.
Chen Y-S, Lin J-W, Yu H-Y, Ko W-J, Jerng J-S, Chang W-T, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372(9638):554–61.CrossRef
12.
Blumenstein J, Leick J, Liebetrau C, Kempfert J, Gaede L, Gross S, et al. Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: a propensity-matched analysis. Eur Heart J Acute Cardiovasc Care. 2016;5(7):13–22.CrossRef
13.
Yannopoulos D, Bartos JA, Raveendran G, Conterato M, Frascone RJ, Trembley A, et al. Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest. J Am Coll Cardiol. 2017;70(9):1109–17.CrossRef
14.
Beyea MM, Tillmann BW, Iansavichene AE, Randhawa VK, Van Aarsen K, Nagpal AD. Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: a systematic review. Resuscitation. 2018;130:146–58.CrossRef
15.
Kagawa E, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S, et al. Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation. 2010;81(8):968–73.CrossRef
16.
Cesana F, Avalli L, Garatti L, Coppo A, Righetti S, Calchera I, et al. Effects of extracorporeal cardiopulmonary resuscitation on neurological and cardiac outcome after ischaemic refractory cardiac arrest. Eur Heart J Acute Cardiovasc Care. 2018;7(5):432–41.CrossRef
17.
St-Onge M, Fan E, Mégarbane B, Hancock-Howard R, Coyte PC. Venoarterial extracorporeal membrane oxygenation for patients in shock or cardiac arrest secondary to cardiotoxicant poisoning: a cost-effectiveness analysis. J Crit Care. 2015;30(2):437.e7–14.CrossRef
18.
Pabst D, Brehm CE. Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support? Am J Emerg Med. 2018;36(4):637–40.CrossRef
19.
Le Guen M, Nicolas-Robin A, Carreira S, Raux M, Leprince P, Riou B, et al. Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care. 2011;15(1):R29.CrossRef
20.
Lamhaut L, Tea V, Raphalen J-H, An K, Dagron C, Jouffroy R, et al. Coronary lesions in refractory out of hospital cardiac arrest (OHCA) treated by extra corporeal pulmonary resuscitation (ECPR). Resuscitation. 2018;126:154–9.CrossRef
Metadata
Title
Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study
Authors
Daniel Patricio
Lorenzo Peluso
Alexandre Brasseur
Olivier Lheureux
Mirko Belliato
Jean-Louis Vincent
Jacques Creteur
Fabio Silvio Taccone
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2320-1

Other articles of this Issue 1/2019

Critical Care 1/2019 Go to the issue

Review

Influenza virus-related critical illness: prevention, diagnosis, treatment

Letter

Comment upon “Time to epinephrine treatment is associated with the risk of mortality in children who achieve sustained ROSC after traumatic out-of-hospital cardiac arrest”

Viewpoint

Videolaryngoscopy in critically ill patients

Letter

The place of dexmedetomidine light sedation in patients with acute brain injury

Letter

Global warming “heating up” the ICU through Candida auris infections: the climate changes theory

Research

Temporal change in characteristics and outcomes of acute kidney injury on renal replacement therapy in intensive care units: analysis of a nationwide administrative database in Japan, 2007–2016