Abstract 262: Impacts of Percutaneous Cardiopulmonary Assisted Devices and Mild Hypothermia Therapy for Out-of-Hospital Cardiac Arrest in Patients From Multicenter Hypothermia Registry in Japan: J-Pulse Hypo-Registry
Background: Prognostic significance of therapeutic hypothermia (TH) in patients with cardiogenic shock who require percutaneous cardiopulmonary assisted devices (PCPS) is not clear. The aim of this study was to assess whether combination of PCPS with TH affords clinical benefits in terms of the 30-day mortality and favorable neurologic outcome (FNO).
Methods: Five years (2005–2009) data from 452 patients treated with TH were available in the multicenter registry in Japan (J-Pulse-Hypo registry), for analysis of efficacy of TH in out-of-hospital cardiac arrest patients. The patients with hemodynamic compromised states were treated with PCPS. FNO was defined as cerebral performance category 1 and 2.
Results: Of total 452 cases with out-of-hospital cardiac arrest patients, PCPS was used in 102 (22.6%) patients. Although there was no significant differences in age, gender, the presence of bystanders, initial ECG findings between PCPS group and non-PCPS group, severer hemodynamic derangements in the PCPS group compared with those in the non-PCPS group were indicated by inter-group differences in maximum blood pressure (BP), blood sugar, pH, and base excess of arterial blood gas at admission and rate of return of spontaneous circulation (ROSC) before admission. The PCPS group was more frequently treated with PCI and IABP than non-PCPS group. The 30-day mortality of PCPS group was significantly higher than that of non-PCPS group (42.6 % vs.13.5%, p<0.01). However, in 358 patients surviving at 30 days, FNO rate of PCPS group (n=58) was comparable to that of non-PCPS group (n=300) (60% vs. 72%, p=0.09), though hemodynamic and metabolic parameters upon admission predicted poorer prognosis in the subgroup of the PCPS group as those in total PCPS group. PCPS group with FNC was more often witnessed at cardiac arrest, more likely to use AED and showed higher rate of ROSC before admission than that with non-FNC.
Conclusions: In patients with out-of-hospital cardiac arrest requiring PCPS, improvement of FNO after surviving acute phase might be afforded by combination of TH with PCPS. Witnessed cardiac arrest, use of AED and ROSC before admission may be important factors of FNC for patients treated with PCPS under TH.
- © 2010 by American Heart Association, Inc.