Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial

Daniel Rob, Jana Smalcova, Ondrej Smid, Ales Kral, Tomas Kovarnik, David Zemanek, Petra Kavalkova, Michal Huptych, Arnost Komarek, Ondrej Franek, Stepan Havranek, Ales Linhart, Jan Belohlavek, Daniel Rob, Jana Smalcova, Ondrej Smid, Ales Kral, Tomas Kovarnik, David Zemanek, Petra Kavalkova, Michal Huptych, Arnost Komarek, Ondrej Franek, Stepan Havranek, Ales Linhart, Jan Belohlavek

Abstract

Background: Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes.

Methods: Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined.

Results: Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001).

Conclusions: In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC.

Trial registration: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.

Keywords: Extracorporeal cardiopulmonary resuscitation; Extracorporeal life support; Extracorporeal membrane oxygenation; Out-of-hospital cardiac arrest; Return of spontaneous circulation.

Conflict of interest statement

The corresponding author (JB) has received lecture honoraria from Maquet Company, Czech Republic. Remaining authors report no conflict of interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Modified consort flow diagram of the Prague OHCA study. ACLS advanced cardiac life support, CPR cardiopulmonary resuscitation, DSMB data safety monitoring board, ICU intensive care unit, ECLS extracorporeal life support, ECPR extracorporeal membrane resuscitation, ROSC return of spontaneous circulation
Fig. 2
Fig. 2
Kaplan–Meier survival curve in the study according to ROSC and ECPR status

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Source: PubMed

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