Elsevier

Resuscitation

Volume 81, Issue 8, August 2010, Pages 968-973
Resuscitation

Clinical paper
Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support

https://doi.org/10.1016/j.resuscitation.2010.03.037Get rights and content

Abstract

Aim

Cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECLS) for in-hospital cardiac arrest (IHCA) patients has been assigned a low-grade recommendation in current resuscitation guidelines. This study compared the outcomes of IHCA and out-of-hospital cardiac arrest (OHCA) patients treated with ECLS.

Methods

A total of 77 patients were treated with ECLS. Baselines characteristics and outcomes were compared for 38 IHCA and 39 OCHA patients.

Results

The time interval between collapse and starting ECLS was significantly shorter after IHCA than after OHCA (25 (21–43) min versus 59 (45–65) min, p < 0.001). The weaning rate from ECLS (61% versus 36%, p = 0.03) and 30-day survival (34% versus 13%, p = 0.03) were higher for IHCA compared with OHCA patients. IHCA patients had a higher rate of favourable neurological outcome compared to OHCA patients, but the difference was not statistically significant (26% versus 10%, p = 0.07). Kaplan–Meier analysis showed improved 30-day and 1-year survival for IHCA patients treated with ECLS compared to OHCA patients who had ECLS. However, multivariate stepwise Cox regression model analysis indicated no difference in 30-day (odds ratio 0.94 (95% confidence interval 0.68–1.27), p = 0.67) and 1-year survival (0.99 (0.73–1.33), p = 0.95).

Conclusion

CPR with ECLS led to more favourable patient outcomes after IHCA compared with OHCA in our patient group. The difference in outcomes for ECLS after IHCA and OHCA disappeared after adjusting for patient factors and the time delay in starting ECLS.

Section snippets

Study populations

We retrospectively collected data from a single-centre ECLS registry of IHCA and OHCA patients admitted to Hiroshima City Hospital between April 2006 and October 2009. The primary endpoint was 30-day survival.

Inclusion criteria of ECPR

When CPR was performed in an IHCA or OHCA patient in Hiroshima City Hospital, a brief and quick evaluation was conducted during CPR to check eligibility for ECLS and to set up the ECLS system. The main criteria for performing ECLS were an age of 18–74 years, ventricular fibrillation (VF)

Baseline characteristics of study patients

A flow diagram of the study patients and their outcomes is shown in Fig. 1. A total of 77 ECLS-treated cardiac arrest patients were enrolled in this study. The baseline clinical characteristics, treatment and findings for the study patients are shown in Table 1, Table 2.

Thirty-eight patients were IHCA and 39 were OHCA. The OHCA patients were significantly younger than the IHCA patients (68 (58–73) years versus 56 (49–64) years, p < 0.01). The percentage of males (58% versus 85%, p < 0.01) and the

Discussion

Following ECLS, the survival rate at 30 days and 1 year was higher in IHCA than in OHCA patients. However, this difference in outcomes between the two sets of patients was mainly due to patient factors and a shorter interval from collapse to starting ECLS after IHCA. ECLS provides temporary total circulatory support with artificial blood flow and increased coronary perfusion. It increases the rate of successful defibrillation, prevents re-arrest from post-resuscitation myocardial dysfunction

Study limitations

This study is a non-randomised observational study which has limitations common to all retrospective investigations. However, all consecutive cardiac arrest patients treated with ECLS were prospectively included in a single-centre registry. This study was not a multi-centre study; the emergency medical systems and in-hospital emergency systems are different in various areas and hospitals.

Conclusions

We demonstrated that outcomes of patients treated with ECLS were better for IHCA patients than OHCA ones. The difference in outcomes for ECLS after IHCA and OHCA disappeared after adjusting for patient factors and the time delay in starting ECLS.

Conflict of interest statement

There is no conflict of interest.

Acknowledgements

We appreciate the efforts of the coronary care unit, cardiology ward, emergency room and catheter laboratory nursing staff at Hiroshima City Hospital, which made this study possible.

References (14)

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.03.037.

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