Evaluating the impact of ELSO guideline adherence on favorable neurological outcomes among patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Akira Kawauchi; Yohei Okada; Makoto Aoki; Tomoko Ogasawara; Takashi Tagami; Nobuya Kitamura; Mitsunobu Nakamura; SOS-KANTO 2017 Study Group

doi:10.1016/j.resuscitation.2024.110218

Evaluating the impact of ELSO guideline adherence on favorable neurological outcomes among patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Resuscitation. 2024 Apr 20:199:110218. doi: 10.1016/j.resuscitation.2024.110218. Online ahead of print.

Authors

Akira Kawauchi¹, Yohei Okada², Makoto Aoki³, Tomoko Ogasawara⁴, Takashi Tagami⁵, Nobuya Kitamura⁶, Mitsunobu Nakamura⁷; SOS-KANTO 2017 Study Group

Affiliations

¹ Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan. Electronic address: a.kawauchi622@gmail.com.
² Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
³ Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan.
⁴ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
⁵ Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
⁶ Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba Japan.
⁷ Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan.

PMID: 38649088
DOI: 10.1016/j.resuscitation.2024.110218

Abstract

Aim: Selecting the appropriate candidates for extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is challenging. Previously, the Extracorporeal Life Support Organization (ELSO) guidelines suggested the example of inclusion criteria. However, it is unclear whether patients who meet the inclusion criteria of the ELSO guidelines have more favorable outcomes. We aimed to evaluate the relationship between the outcomes and select inclusion criteria of the ELSO guidelines.

Methods: We conducted a post-hoc analysis of a multicenter prospective study conducted between 2019 and 2021. Adult patients with OHCA treated with ECPR were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. An ELSO criteria score was assigned based on four criteria: (i) age < 70 years; (ii) witness; (iii) bystander CPR; and (iv) low-flow time (<60 min). Subgroup analysis based on initial cardiac rhythm was performed.

Results: Among 9,909 patients, 227 with OHCA were included. The proportion of favorable neurological outcomes according to the number of ELSO criteria met were: 0.0% (0/3), 0 points; 0.0% (0/23), 1 point; 3.0% (2/67), 2 points; 7.3% (6/82), 3 points; and 16.3% (7/43), 4 points. A similar tendency was observed in patients with an initial shockable rhythm. However, no such relationship was observed in those with an initial non-shockable rhythm.

Conclusion: Patients who adhered more closely to specific inclusion criteria of the ELSO guidelines demonstrated a tendency towards a higher rate of favorable neurological outcomes. However, the relationship was heterogeneous according to initial rhythm.

Keywords: Cardiac rhythm; ELSO guidelines; Extracorporeal cardiopulmonary resuscitation; Neurological outcomes; Out-of-hospital cardiac arrest; Patient selection.