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Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial

Background Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may incr...

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Published in:Critical care (London, England) England), 2022-10, Vol.26 (1), p.1-330, Article 330
Main Authors: Rob, Daniel, Smalcova, Jana, Smid, Ondrej, Kral, Ales, Kovarnik, Tomas, Zemanek, David, Kavalkova, Petra, Huptych, Michal, Komarek, Arnost, Franek, Ondrej, Havranek, Stepan, Linhart, Ales, Belohlavek, Jan
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container_title Critical care (London, England)
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creator Rob, Daniel
Smalcova, Jana
Smid, Ondrej
Kral, Ales
Kovarnik, Tomas
Zemanek, David
Kavalkova, Petra
Huptych, Michal
Komarek, Arnost
Franek, Ondrej
Havranek, Stepan
Linhart, Ales
Belohlavek, Jan
description Background Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. Methods Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. Results Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001). Conclusions In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. Trial registration: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012. Keywords: Out-of-hospital cardiac arrest, Extracorporeal life support, Extracorporeal membrane oxygenation, Extracorporeal cardiopulmonary resuscitation, Return of spontaneous circulation
doi_str_mv 10.1186/s13054-022-04199-3
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Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. Methods Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. Results Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p &lt; 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P &lt; 0.001). Conclusions In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. Trial registration: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012. Keywords: Out-of-hospital cardiac arrest, Extracorporeal life support, Extracorporeal membrane oxygenation, Extracorporeal cardiopulmonary resuscitation, Return of spontaneous circulation</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1364-8535</identifier><identifier>EISSN: 1366-609X</identifier><identifier>EISSN: 1466-609X</identifier><identifier>DOI: 10.1186/s13054-022-04199-3</identifier><language>eng</language><publisher>London: BioMed Central Ltd</publisher><subject>Cardiac arrest ; Cardiopulmonary resuscitation ; Care and treatment ; Consent ; CPR ; CPR (First aid) ; Critical care ; Enrollments ; Extracorporeal cardiopulmonary resuscitation ; Extracorporeal life support ; Extracorporeal membrane oxygenation ; Intervention ; Life support systems (Critical care) ; Medical prognosis ; Methods ; Out-of-hospital cardiac arrest ; Patients ; Return of spontaneous circulation ; Software ; Testing</subject><ispartof>Critical care (London, England), 2022-10, Vol.26 (1), p.1-330, Article 330</ispartof><rights>COPYRIGHT 2022 BioMed Central Ltd.</rights><rights>2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-80a3093b985ab2dad60123a50688b434dc4355e28d030ac2fe63b74909e0961d3</citedby><cites>FETCH-LOGICAL-c540t-80a3093b985ab2dad60123a50688b434dc4355e28d030ac2fe63b74909e0961d3</cites><orcidid>0000-0001-9455-9224</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608889/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2737650181?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids></links><search><creatorcontrib>Rob, Daniel</creatorcontrib><creatorcontrib>Smalcova, Jana</creatorcontrib><creatorcontrib>Smid, Ondrej</creatorcontrib><creatorcontrib>Kral, Ales</creatorcontrib><creatorcontrib>Kovarnik, Tomas</creatorcontrib><creatorcontrib>Zemanek, David</creatorcontrib><creatorcontrib>Kavalkova, Petra</creatorcontrib><creatorcontrib>Huptych, Michal</creatorcontrib><creatorcontrib>Komarek, Arnost</creatorcontrib><creatorcontrib>Franek, Ondrej</creatorcontrib><creatorcontrib>Havranek, Stepan</creatorcontrib><creatorcontrib>Linhart, Ales</creatorcontrib><creatorcontrib>Belohlavek, Jan</creatorcontrib><title>Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial</title><title>Critical care (London, England)</title><description>Background Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. Methods Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. Results Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p &lt; 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P &lt; 0.001). Conclusions In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. Trial registration: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012. 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Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. Methods Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. Results Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p &lt; 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P &lt; 0.001). Conclusions In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. Trial registration: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012. Keywords: Out-of-hospital cardiac arrest, Extracorporeal life support, Extracorporeal membrane oxygenation, Extracorporeal cardiopulmonary resuscitation, Return of spontaneous circulation</abstract><cop>London</cop><pub>BioMed Central Ltd</pub><doi>10.1186/s13054-022-04199-3</doi><orcidid>https://orcid.org/0000-0001-9455-9224</orcidid><oa>free_for_read</oa></addata></record>
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subjects Cardiac arrest
Cardiopulmonary resuscitation
Care and treatment
Consent
CPR
CPR (First aid)
Critical care
Enrollments
Extracorporeal cardiopulmonary resuscitation
Extracorporeal life support
Extracorporeal membrane oxygenation
Intervention
Life support systems (Critical care)
Medical prognosis
Methods
Out-of-hospital cardiac arrest
Patients
Return of spontaneous circulation
Software
Testing
title Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial
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