Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: A registry study

Wulfran Bougouin, Florence Dumas, Lionel Lamhaut, Eloi Marijon, Pierre Carli, Alain Combes, Romain Pirracchio, Nadia Aissaoui, Nicole Karam, Nicolas Deye, Georgios Sideris, Frankie Beganton, Daniel Jost, Alain Cariou, Xavier Jouven, F. Adnet, J. M. Agostinucci, N. Aissaoui-Balanant, V. Algalarrondo, F. AllaC. Alonso, W. Amara, D. Annane, C. Antoine, P. Aubry, E. Azoulay, F. Beganton, D. Benhamou, C. Billon, W. Bougouin, J. Boutet, C. Bruel, P. Bruneval, A. Cariou, P. Carli, E. Casalino, C. Cerf, A. Chaib, B. Cholley, Y. Cohen, A. Combes, M. Crahes, D. Da Silva, V. Das, A. Demoule, I. Denjoy, N. Deye, G. Dhonneur, J. L. Diehl, S. Dinanian, L. Domanski, D. Dreyfuss, D. Duboc, J. L. Dubois-Rande, F. Dumas, J. P. Empana, F. Extramiana, M. Fartoukh, F. Fieux, M. Gabbas, E. Gandjbakhch, G. Geri, B. Guidet, F. Halimi, P. Henry, F. Hidden Lucet, P. Jabre, L. Jacob, L. Joseph, D. Jost, X. Jouven, N. Karam, H. Kassim, J. Lacotte, K. Lahlou-Laforet, L. Lamhaut, A. Lanceleur, O. Langeron, T. Lavergne, E. Lecarpentier, A. Leenhardt, N. Lellouche, V. Lemiale, F. Lemoine, F. Linval, T. Loeb, B. Ludes, C. E. Luyt, A. Maltret, N. Mansencal, N. Mansouri, E. Marijon, J. Marty, E. Maury, V. Maxime, B. Megarbane, A. Mekontso-Dessap, H. Mentec, J. P. Mira, X. Monnet, K. Narayanan, N. Ngoyi, M. C. Perier, O. Piot, R. Pirracchio, P. Plaisance, I. Plu, M. Raux, F. Revaux, J. D. Ricard, C. Richard, B. Riou, F. Roussin, F. Santoli, F. Schortgen, A. Sharifzadehgan, G. Sideris, C. Spaulding, J. L. Teboul, J. F. Timsit, J. P. Tourtier, P. Tuppin, C. Ursat, O. Varenne, A. Vieillard-Baron, S. Voicu, K. Wahbi, V. Waldmann

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Aims: Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results: We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8-2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5-1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5-10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1-4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5-5.9; P = 0.002). Conclusions: In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

Original languageEnglish (US)
Pages (from-to)1961-1971
Number of pages11
JournalEuropean Heart Journal
Volume41
Issue number21
DOIs
StatePublished - Jun 1 2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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