title: Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.
abstract: BACKGROUND
  Extracorporeal life-support as an adjunct to cardiac resuscitation has shown encouraging outcomes in patients with cardiac arrest. However, there is little evidence about the benefit of the procedure compared with conventional cardiopulmonary resuscitation (CPR), especially when continued for more than 10 min. We aimed to assess whether extracorporeal CPR was better than conventional CPR for patients with in-hospital cardiac arrest of cardiac origin.
  
  
  METHODS
  We did a 3-year prospective observational study on the use of extracorporeal life-support for patients aged 18-75 years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min compared with patients receiving conventional CPR. A matching process based on propensity-score was done to equalise potential prognostic factors in both groups, and to formulate a balanced 1:1 matched cohort study. The primary endpoint was survival to hospital discharge, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00173615.
  
  
  RESULTS
  Of the 975 patients with in-hospital cardiac arrest events who underwent CPR for longer than 10 min, 113 were enrolled in the conventional CPR group and 59 were enrolled in the extracorporeal CPR group. Unmatched patients who underwent extracorporeal CPR had a higher survival rate to discharge (log-rank p<0.0001) and a better 1-year survival than those who received conventional CPR (log rank p=0.007). Between the propensity-score matched groups, there was still a significant difference in survival to discharge (hazard ratio [HR] 0.51, 95% CI 0.35-0.74, p<0.0001), 30-day survival (HR 0.47, 95% CI 0.28-0.77, p=0.003), and 1-year survival (HR 0.53, 95% CI 0.33-0.83, p=0.006) favouring extracorporeal CPR over conventional CPR.
  
  
  CONCLUSIONS
  Extracorporeal CPR had a short-term and long-term survival benefit over conventional CPR in patients with in-hospital cardiac arrest of cardiac origin.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Hsi-Yu
authors.initials: HY
authors.lastname: Yu
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Jih-Shuin
authors.initials: JS
authors.lastname: Jerng
authors.forename: Wei-Tien
authors.initials: WT
authors.lastname: Chang
authors.forename: Wen-Jone
authors.initials: WJ
authors.lastname: Chen
authors.forename: Shu-Chien
authors.initials: SC
authors.lastname: Huang
authors.forename: Nai-Hsin
authors.initials: NH
authors.lastname: Chi
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Li-Chin
authors.initials: LC
authors.lastname: Chen
authors.forename: Pi-Ru
authors.initials: PR
authors.lastname: Tsai
authors.forename: Sheoi-Shen
authors.initials: SS
authors.lastname: Wang
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.forename: Fang-Yue
authors.initials: FY
authors.lastname: Lin
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005112:Extracorporeal Circulation; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies