Journal article
Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial
Critical care (London, England), Vol.26(1), pp.1-330
10/27/2022
DOI: 10.1186/s13054-022-04199-3
PMCID: PMC9608889
PMID: 36303227
Abstract
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.
Details
- Title: Subtitle
- Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial
- Creators
- Daniel Rob - Charles UniversityJana Smalcova - Charles UniversityOndrej Smid - Charles UniversityAles Kral - Charles UniversityTomas Kovarnik - General University Hospital in PragueDavid Zemanek - Charles UniversityPetra Kavalkova - Charles UniversityMichal Huptych - Czech Technical University in PragueArnost Komarek - Charles UniversityOndrej FranekStepan Havranek - Charles UniversityAles Linhart - General University Hospital in PragueJan Belohlavek - General University Hospital in Prague
- Resource Type
- Journal article
- Publication Details
- Critical care (London, England), Vol.26(1), pp.1-330
- Publisher
- Springer Nature
- DOI
- 10.1186/s13054-022-04199-3
- PMID
- 36303227
- PMCID
- PMC9608889
- ISSN
- 1364-8535
- eISSN
- 1466-609X
- Number of pages
- 9
- Grant note
- CZ-DRO-VFN64165 / MH VFN: General University Hospital in Prague Charles University Research program "Cooperatio Intensive Care Medicine
- Language
- English
- Date published
- 10/27/2022
- Academic Unit
- Electrical and Computer Engineering
- Record Identifier
- 9984627235202771
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