Abstract 2705: Changes in the Treatment Strategy for Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation
Background: The effect of extracorporeal cardiopulmonary resuscitation (ECPR) on patients who have out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) and do not respond to standard advanced cardiovascular life support (ALS) remains unclear.
Objective: To compare the effect of ECPR after arrival at the hospital in patients who have OHCA with VF between two multicenter retrospective studies: the Survey Of Survivors after out-of-hospital cardiac arrest in the KANTO area (SOS-KANTO) and the Pilot Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J-Pilot). SOS-KANTO was performed during the 2 years from 2002 through 2004 and had 58 participating centers and 9,592 registered patients with OHCA, including 86 who received ECPR. SAVE-J-Pilot was performed for 1 year in 2006 and had 5 participating centers and 1,220 registered patients with OHCA, including 50 who received ECPR.
Methods: We compared the outcomes (rates of survival to discharge and of favorable neurologic recovery) of the patients who received ECPR in each of the studies with those of the patients in the SOS-KANTO study who received conventional ALS with no ECPR and no therapeutic hypothermia (conventional ALS) (N = 431).
Results: The rate of survival to discharge (conventional ALS: 3%, SOS-KANTO ECPR: 14%, SAVE-J-Pilot ECPR: 34%, p < 0.01) and the rate of favorable neurologic recovery (2%, 9%, 13%, p < 0.05) differed significantly among the groups. The rate of therapeutic hypothermia (23% vs. 63%, p < 0.01), the rate of emergency percutaneous coronary intervention (29% vs. 53%, p < 0.01) and the rate of intra-aortic balloon pumping (46% vs. 71%, p < 0.01) differed significantly between the SOS-KANTO ECPR group and the SAVE-J-Pilot ECPR group.
Conclusions: Although the times and background characteristics of the studies differed, our results suggested that therapeutic hypothermia, intra-aortic balloon pumping, and emergency percutaneous coronary intervention contributed to improved outcomes. Improvements in treatment strategies for patients who receive ECPR are necessary to increase the rate of favorable neurologic recovery in patients who have OHCA with VF.