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Etiology-Based Prognosis of Extracorporeal CPR Recipients After Out-of-Hospital Cardiac Arrest: A Retrospective

Toru Takiguchi1, Naoki Tominaga2, Takuro Hamaguchi2

  • 1Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.

Chest
|October 25, 2023
PubMed

Insights

Extracorporeal CPR (ECPR) for out-of-hospital cardiac arrest (OHCA) shows better outcomes for accidental hypothermia. Acute aortic dissection and primary cerebral disorders are associated with poor survival compared to cardiac causes.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Critical Care Medicine

Background:

  • Understanding factors influencing outcomes in extracorporeal CPR (ECPR) is crucial for patient selection in out-of-hospital cardiac arrest (OHCA).
  • Limited evidence exists comparing prognoses based on different cardiac arrest etiologies.
  • This study addresses the need for etiology-based prognostic comparisons in ECPR for OHCA.

Purpose of the Study:

  • To determine the etiology-based prognosis of patients undergoing ECPR for OHCA.
  • To compare neurologic outcomes and survival rates across various cardiac arrest causes.

Main Methods:

  • Retrospective multicenter registry study of adult OHCA patients undergoing ECPR (January 2013-December 2018) across 36 Japanese institutions.
  • Etiology of OHCA was determined retrospectively from hospital data.
  • Multivariable logistic regression analysis was used to assess the association between cardiac arrest etiology and favorable neurologic outcome and survival at hospital discharge.

Main Results:

  • 1,781 patients were included; 78.9% had cardiac arrest due to cardiac causes.
  • Accidental hypothermia was associated with significantly higher rates of favorable neurologic outcome (aOR, 5.12) and survival (aOR, 5.19) compared to cardiac causes.
  • Acute aortic dissection/aneurysm (aOR, 0.07) and primary cerebral disorders (aOR, 0.12) were associated with significantly lower survival rates than cardiac causes.

Conclusions:

  • While most OHCA patients undergoing ECPR have cardiac etiologies, accidental hypothermia is linked to better neurologic outcomes and survival.
  • Conversely, acute aortic dissection/aneurysm and primary cerebral disorders are associated with poorer survival outcomes compared to cardiac causes.
  • Etiology is a significant factor in predicting ECPR success for OHCA patients.
Abstract

Keywords:
accidental hypothermiaacute aortic dissectioncerebral disordersetiologyextracorporeal cardiopulmonary resuscitationout-of-hospital cardiac arrestoutcomepulmonary embolism

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