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