Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest = Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest

다국어 초록 (Multilingual Abstract)

Object: Extracorporeal cardiopulmonary resuscitation (ECPR) has been described as an alternative methods of refractory arrest in patients who receiving conventional cardiopulmonary resuscitation (CCPR) in cardiac arrest. However, there is no study on the clear evidence about the merits of ECPR in out-of-hospital cardiac arrest (OHCA), compared with CCPR. Moreover the upper time limit, which can predict a favorable neurologic outcome before initiating ECPR, has not been established in witnessed OHCA patients. We intended to find the merits of clinical outcome in ECPR by comparison with CCPR using propensity score matching method. We also tried to estimate the upper limit of adequate time to deploy ECPR for a favorable outcome. Methods: This was retrospective cohort study. We compared the outcomes of ECPR and CCPR in nontraumatic witnessed OHCA adults who underwent CPR for longer than 15 minutes. Propensity score matching was used to adjust confounding factors in non-randomized CPR registry. In-hospital CPR duration and total no/low-flow duration and were discriminated on the cut-off time. Subgroups based on the cut-off time, were analyzed after matching for finding the adequate time to predict good or poor neurologic outcome. Results: Of 299 patients who had age≥18 years, witnessed OHCA, no trauma, and no DNR, 195 patients underwent CPR for longer than 15 minutes, 156 were enrolled in the CCPR group and 39 were enrolled in ECPR group. The unmatched and matched ECPR group showed the tendency of three-month good neurologic outcome among survivors at discharge (unmatched p=0.018; matched: p=0.012). The cut-off value of inhospital CPR duration and total no/low-time duration for survival event (Return of Spontaneous Circulation≥ 20 minutes) in overall patients with CCPR were 25 minutes, and 47 minutes, respectively. The matched ECPR group with in-hospital CPR duration of over 25 minutes, had better neurologic outcome than the matched CCPR group at three month after arrest (p=0.033). Conclusion: ECPR had a favorable neurologic outcome better than CCPR in survivors at discharge. We suggest to consider ECPR when in-hospital CPR duration over 25 minutes as the upper limit before ECPR in OHCA patients.