Extracorporeal cardiopulmonary resuscitation without target temperature management for out-of-hospital cardiac arrest patients prolongs the therapeutic time window: a retrospective analysis of a nationwide multicentre observational study in Japan
Tóm tắt
Extracorporeal cardiopulmonary resuscitation (ECPR) with extracorporeal membrane oxygenation (ECMO) is a promising therapy for out-of-hospital cardiac arrest (OHCA) compared with conventional cardiopulmonary resuscitation (CCPR). The no and low-flow time (NLT), the interval from collapse to reperfusion to starting ECMO or to the return of spontaneous circulation (ROSC) in CCPR, is associated with the neurological outcome of OHCA. Because the effects of target temperature management (TTM) on the outcomes of ECPR are unclear, we compared the neurological outcomes of OHCA between ECPR and CCPR without TTM. We performed retrospective subanalyses of the Japanese Association for Acute Medicine OHCA registry. Witnessed cases of adult cardiogenic OHCA without TTM were selected. We performed univariate, multivariable and propensity score analyses to compare the neurological outcomes after ECPR or CCPR in all eligible patients and in patients with NLT of > 30 min or > 45 min. We analysed 2585 cases. Propensity score analysis showed negative result in all patients (odds ratio 0.328 [95% confidence interval 0.141–0.761], P = 0.010). However, significant associated with better neurological outcome was shown in patients with NLT of > 30 min or > 45 min (odds ratio 2.977 [95% confidence interval 1.056–8.388], P = 0.039, odds ratio 5.099 [95% confidence interval 1.259–20.657], P = 0.023, respectively). This study revealed significant differences in the neurological outcomes between ECPR and CCPR without TTM, in patients with NLT of > 30 min.
Tài liệu tham khảo
Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in adult patients. J Am Heart Assoc. 2020;9:e015291. https://doi.org/10.1161/JAHA.119.015291.
Holmberg MJ, Geri G, Wiberg S, Guerguerian AM, Donnino MW, Nolan JP, et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review. Resuscitation. 2018;131:91–100.
Beyea MM, Tillmann BW, Iansavichene AE, Randhawa VK, Van Aarsen K, Nagpal AD. Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: a systematic review. Resuscitation. 2018;130:146–58.
Hutin A, Abu-Habsa M, Burns B, Bernard S, Bellezzo J, Shinar Z, et al. Early ECPR for out-of-hospital cardiac arrest: best practice in 2018. Resuscitation. 2018;130:44–8.
Lunz D, Calabrό L, Belliato M, Contri E, Broman LM, Scandroglio AM, et al. Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study. Intensive Care Med. 2020; [Epub ahead of print].
Poppe M, Schriefl C, Steinacher A, Clodi C, Warenits AM, Nümberger A, et al. Extracorporeal cardiopulmonary resuscitation at the emergency department: a retrospective patient selection evaluation. Eur J Anaesthesiol. 2020;37:280–5.
Axtell AL, Funamoto M, Legassey AG, Moonsamy P, Shelton K, D’Alessandro DA, et al. Predictors of neurologic recovery in patients who undergo extracorporeal membrane oxygenation for refractory cardiac arrest. J Cardiothorac Vasc Anesth. 2020;34:356–62.
Otani T, Sawano H, Hayashi Y. Optimal extracorporeal cardiopulmonary resuscitation inclusion criteria for favorable neurological outcomes: a single-center retrospective analysis. Acute Med Surg. 2020;7:e477. https://doi.org/10.1002/ams2.447.
Nakashima T, Noguchi T, Tahara Y, Nishimura K, Ogata S, Yasuda S, et al. Patients with refractory out-of-cardiac arrest and sustained ventricular fibrillation as candidates for extracorporeal cardiopulmonary resuscitation -prospective multi-center observational study. Circ J. 2019;83:1011–8.
Ryu JA, Chung CR, Cho YH, Sung K, Jeon K, Suh GY, et al. Neurologic outcome in patients who undergo extracorporeal cardiopulmonary resuscitation. AnnThorac Surg. 2019;108:749–55.
Otani T, Sawano H, Natsukawa T, Nakashima T, Oku H, Gon C, et al. Low-flow time is associated with a favorable neurological outcome in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation. J Crit Care. 2018;48:15–20.
Yu HY, Wang CH, Chi NH, Huang SC, Chou HW, Chou NK, et al. Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation. Intensive Care Med. 2019;45:44–54.
Chen X, Zhen Z, Na J, Wang Q, Gao L, Yuan Y. Association of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis. Scand J Trauma Resusc Emerg Med. 2020;28:3. https://doi.org/10.1186/s13049-019-0698-z.
Kim YS, Cho YH, Sung K, Ryu JA, Chung CR, Suh GY, et al. Target temperature management may not improve clinical outcomes of extracorporeal cardiopulmonary resuscitation. J Intensive Care Med. 2019;34:790–6.
Kitamura T, Iwami T, Atsumi T, Endo T, Kanna T, Kuroda Y, et al. The profile of Japanese Association of Acute Medicine -out-of-hospital cardiac arrest registry in 2014-2015. Acute Med Surg. 2018;5:249–58.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1:480–4.
Twohig CJ, Singer B, Grier G, Finney SJ. A systematic literature review and meta-analysis of the effectiveness of extracorporeal-CPR versus conventional-CPR for adult patients in cardiac arrest. J Intensive Care Soc. 2019;20:347–57.
Matsuoka Y, Ikenoue T, Hata N, Taguri M, Itaya T, Ariyoshi K, et al. Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: a population-based study. Resuscitation. 2019;136:85–92.
Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2014;85:762–8.
Patricio D, Peluso L, Brasseur A, Lheureux O, Belliato M, Vincent JL, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care. 2019;23:27.
Bartos JA, Grunau B, Carlson C, Duval S, Ripeckyj A, Kalra R, et al. Improved survival with extracorporeal cardiopulmonary resuscitation despite progressive metabolic derangement associated with prolonged resuscitation. Circulation. 2020;141:877–86.
Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, et al. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J. 2019. https://doi.org/10.1093/eurheartj/ehz753 [Epub ahead of print].