Hospitals' extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

Resuscitation. 2019 Mar;136:85-92. doi: 10.1016/j.resuscitation.2019.01.013. Epub 2019 Jan 19.

Abstract

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is the emerging resuscitative strategy to save refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) patients. We investigated whether the receiving hospitals' ECPR capabilities are associated with outcomes in out-of-hospital cardiac arrest (OHCA) patients who have refractory VF or pulseless VT.

Methods: In a population-based cohort study performed in Kobe City, Japan, between 2010 and 2017, we identified all OHCA patients who had refractory VF or pulseless VT. Based on their ECPR capabilities, hospitals were categorised into ECPR facilities and conventional cardiopulmonary resuscitation (CCPR) facilities. We compared patient survivals between ECPR facilities and CCPR facilities by applying inverse probability weighting using a propensity score.

Results: Of all 10,971 OHCA patients, 518 had refractory VF or pulseless VT. The proportion of favourable neurologic outcomes was 43/188 (22.9%) in ECPR facilities and 28/330 (8.5%) in CCPR facilities. In the propensity analysis, hospitals' ECPR capabilities were associated with favourable neurologic outcomes (adjusted risk difference [ARD], 9.7% [95% confidence interval [CI], 3.7%-15.7%]; adjusted risk ratio [ARR], 2.01 [95% CI, 1.31-3.09]), and overall survival (87/188 [46.3%] vs. 67/330 [20.3%]; ARD, 19.0% [95% CI, 11.1%-26.9%]; ARR, 1.88 [95% CI, 1.45-2.44]).

Conclusions: Hospitals' ECPR capabilities were associated with favourable neurologic outcomes in OHCA patients who had refractory VF or pulseless VT. We should take each hospital's ECPR capability into consideration when developing a regional system of care for OHCA.

Keywords: Emergency medical services; Extracorporeal cardiopulmonary resuscitation; Hospital characteristics; Out-of-hospital cardiac arrest.

MeSH terms

  • Aged
  • Cardiopulmonary Resuscitation / mortality*
  • Extracorporeal Membrane Oxygenation / mortality*
  • Female
  • Hospitals / classification*
  • Hospitals / statistics & numerical data
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / etiology
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Prospective Studies
  • Registries
  • Treatment Outcome
  • Ventricular Fibrillation / complications