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

Takahiro Nakashima; Teruo Noguchi; Yoshio Tahara; Kunihiro Nishimura; Soshiro Ogata; Satoshi Yasuda; Daisuke Onozuka; Naoto Morimura; Ken Nagao; David F Gaieski; Yasufumi Asai; Hiroyuki Yokota; Satoshi Nara; Mamoru Hase; Takahiro Atsumi; Tetsuya Sakamoto; for the SAVE-J Group

doi:10.1253/circj.CJ-18-1257

Critical Care

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

Takahiro Nakashima, Teruo Noguchi, Yoshio Tahara, Kunihiro Nishimura, Soshiro Ogata, Satoshi Yasuda, Daisuke Onozuka, Naoto Morimura, Ken Nagao, David F Gaieski, Yasufumi Asai, Hiroyuki Yokota, Satoshi Nara, Mamoru Hase, Takahiro Atsumi, Tetsuya Sakamoto, for the SAVE-J Group

Author information

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

Keywords: Extracorporeal life support, Extracorporeal membrane oxygenation, Favorable neurological outcome

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Supplementary material

2019 Volume 83 Issue 5 Pages 1011-1018

DOI https://doi.org/10.1253/circj.CJ-18-1257

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Abstract

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).

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.

Conclusions: OHCA patients with sustained VF/pVT may be the most promising ECPR candidates (UMIN000001403).

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