title: Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.
abstract: BACKGROUND
  A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR). Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes.
  
  
  RESULTS
  The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively.
  
  
  CONCLUSIONS
  In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Tetsuya
authors: T
authors: Sakamoto
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan. Electronic address: molimula@yokohama-cu.ac.
authors: Naoto
authors: N
authors: Morimura
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Ken
authors: K
authors: Nagao
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Yasufumi
authors: Y
authors: Asai
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Hiroyuki
authors: H
authors: Yokota
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Satoshi
authors: S
authors: Nara
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Mamoru
authors: M
authors: Hase
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Yoshio
authors: Y
authors: Tahara
authors: The Japanese Scientific Research Group of the Ministry of Health, Labour and Welfare for Extracorporeal Cardiopulmonary Resuscitation: Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J), Japan.
authors: Takahiro
authors: T
authors: Atsumi
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies
keywords: Advanced life support; Cardiopulmonary resuscitation; Extracorporeal cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Percutaneous cardiopulmonary support; Ventricular fibrillation