Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: propensity analysis of three-year data.
OBJECTIVE
Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to have survival benefit over conventional CPR (CCPR) in patients with in-hospital cardiac arrest of cardiac origin. We compared the survival of patients who had return of spontaneous beating (ROSB) after ECPR with the survival of those who had return of spontaneous circulation (ROSC) after conventional CPR.


METHODS
Propensity score-matched cohort of adults with in-hospital prolonged CPR (>10min) of cardiac origin in a university-affiliated tertiary extracorporeal resuscitation center were included in this study. Fifty-nine patients with ROSB after ECPR and 63 patients with sustained ROSC by CCPR were analyzed. Main outcome measures were survival at hospital discharge, 30 days, 6 months, and one year, and neurological outcome.


RESULTS
There was no statistical difference in survival to discharge (29.1% of ECPR responders vs. 22.2% of CCPR responders, p=0.394) and neurological outcome at discharge and one year later. In the propensity score-matched groups, 9 out of 27 ECPR patients survived to one month (33.3%) and 7 out of 27 CCPR patients survived (25.9%). Survival analysis showed no survival difference (HR: 0.856, p=0.634, 95% CI: 0.453-1.620) between the groups, either at 30 days or at the end of one year (HR: 0.602, p=0.093, 95% CI: 0.333-1.088).


CONCLUSIONS
This study failed to demonstrate a survival difference between patients who had ROSB after institution of ECMO and those who had ROSC after conventional CPR. Further studies evaluating the role of ECMO in conventional CPR rescued patients are warranted.
Lin
Jou-Wei
JW
Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin, Taiwan.
Wang
Ming-Jiuh
MJ
Yu
Hsi-Yu
HY
Wang
Chih-Hsien
CH
Chang
Wei-Tien
WT
Jerng
Jih-Shuin
JS
Huang
Shu-Chien
SC
Chou
Nai-Kuan
NK
Chi
Nai-Hsin
NH
Ko
Wen-Je
WJ
Wang
Ya-Chen
YC
Wang
Shoei-Shen
SS
Hwang
Juey-Jen
JJ
Lin
Fang-Yue
FY
Chen
Yih-Sharng
YS
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult