Patients With Refractory Out-of-Cardiac Arrest and Sustained Ventricular Fibrillation as Candidates for Extracorporeal Cardiopulmonary Resuscitation　― Prospective Multi-Center Observational Study ―

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  • Nakashima Takahiro
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
  • Noguchi Teruo
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre
  • Tahara Yoshio
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre
  • Nishimura Kunihiro
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre
  • Ogata Soshiro
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre
  • Yasuda Satoshi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
  • Onozuka Daisuke
    Department of Health Communication, Kyushu University Graduate School of Medical Sciences
  • Morimura Naoto
    Department of Emergency and Critical Care Medicine, The University of Tokyo
  • Nagao Ken
    Cardiovascular Centre, Nihon University Hospital
  • Gaieski David F
    Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University
  • Asai Yasufumi
    Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Yokota Hiroyuki
    Department of Emergency and Critical Care Medicine, Nippon Medical School
  • Nara Satoshi
    Emergency and Critical Care Medical Centre, Teine Keijinkai Hospital
  • Hase Mamoru
    Cardiovascular Centre, Sapporo Teishinkai Hospital
  • Atsumi Takahiro
    Department of Emergency Medicine, Seirei Hamamatsu General Hospital
  • Sakamoto Tetsuya
    Department of Emergency Medicine, Teikyo University
  • for the SAVE-J Group

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Other Title
  • Patients with refractory out-of-cardiac arrest and sustained ventricular fibrillation as candidates for extracorporeal cardiopulmonary resuscitation—prospective multi-center observational study.
  • Patients with refractory out-of-hospital cardiac arrest and sustained ventricular fibrillation as candidates for extracorporeal cardiopulmonary resuscitation – Prospective multi-center observational study

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Abstract

<p>Background: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) and sustained ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) or conversion to pulseless electrical activity/asystole (PEA/asystole) benefit more from extracorporeal cardiopulmonary resuscitation (ECPR). </p><p>Methods and Results: We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, which was a prospective, multicenter, observational study with 22 institutions in the ECPR group and 17 institutions in the conventional CPR (CCPR) group. Patients were divided into 4 groups by cardiac rhythm and CPR group. The primary endpoint was favorable neurological outcome, defined as Cerebral Performance Category 1 or 2 at 6 months. A total of 407 patients had refractory OHCA with VF/pVT on initial electrocardiogram. The proportion of ECPR patients with favorable neurological outcome was significantly higher in the sustained VF/pVT group than in the conversion to PEA/asystole group (20%, 25/126 vs. 3%, 4/122, P<0.001). Stratifying by cardiac rhythm, on multivariable mixed logistic regression analysis an ECPR strategy significantly increased the proportion of patients with favorable neurological outcome at 6 months in the patients with sustained VF/pVT (OR, 7.35; 95% CI: 1.58–34.09), but these associations were not observed in patients with conversion to PEA/asystole. </p><p>Conclusions: OHCA patients with sustained VF/pVT may be the most promising ECPR candidates (UMIN000001403). </p>

Journal

  • Circulation Journal

    Circulation Journal 83 (5), 1011-1018, 2019-04-25

    The Japanese Circulation Society

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