Abstract P77: An In-depth Review of Case-series of Out-of-hospital Cardiac Arrest with Extracorporeal Cardiopulmonary Resuscitation in Japan
Background: It is difficult to supply sufficient cerebral blood flow during chest compression for cardiac arrest. Attention has been paid to extracorporeal cardiopulmonary resuscitation (ECPR) from a point of view of the neurological outcome improvement. Although a lot of case reports regarding ECPR in Japanese were shown, there was no report that accumulated those cases.
Methods: We collected case-report and case-series of ECPR for out-of-hospital cardiac arrest written in Japanese between January 1983 and July 2007. In-depth review was conducted to the case of all case-report and the case with detailed description of clinical course of case-series in order to clarify the outcome and characteristics.
Results: One hundred and twenty six out-of-hospital cardiac arrest cases were enrolled to this study (33 from case-report and 92 from case-series). The mean age was 45 ± 21 years and 68.3% was male. The cause of arrest was cardiac in 79 cases (62.7%). There were 65 cases (51.6%) of arrest witnessed and 40 cases (31.7%) with bystander CPR. There was no significant difference of the rate of survival to hospital discharge between the case with cardiac etiology and that of non-cardiac etiology (59.1% (39/66) vs. 79.2% (19/24), Odds Ratio=2.63 (0.88 –7.90), p=0.078). The rate of survival to hospital discharge of the case with ventricular fibrillation (VF) before the introduction of ECPR did not significantly differ from non-VF cases (72.5% (29/40) vs. 52.4% (11/21), Odds Ratio=2.40 (0.80 –7.21), p=0.116, sample power=33%). The rate of good recovery (GR) and favorable neurological recovery (GR and MD) at hospital discharge in total cases were 31.7%, 77.7%, respectively.
Conclusions: ECPR may provide favorable neurological outcome of out-of-hospital cardiac arrest. Multi-center large prospective trial is needed to determine the efficacy.