Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.
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.
Chen
Yih-Sharng
YS
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Lin
Jou-Wei
JW
Yu
Hsi-Yu
HY
Ko
Wen-Je
WJ
Jerng
Jih-Shuin
JS
Chang
Wei-Tien
WT
Chen
Wen-Jone
WJ
Huang
Shu-Chien
SC
Chi
Nai-Hsin
NH
Wang
Chih-Hsien
CH
Chen
Li-Chin
LC
Tsai
Pi-Ru
PR
Wang
Sheoi-Shen
SS
Hwang
Juey-Jen
JJ
Lin
Fang-Yue
FY
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