Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka

Yohei Okada; Taro Irisawa; Tomoki Yamada; Kazuhisa Yoshiya; Changhwi Park; Tetsuro Nishimura; Takuya Ishibe; Hitoshi Kobata; Takeyuki Kiguchi; Masafumi Kishimoto; Sung-Ho Kim; Yusuke Ito; Taku Sogabe; Takaya Morooka; Haruko Sakamoto; Keitaro Suzuki; Atsunori Onoe; Tasuku Matsuyama; Daisuke Kobayashi; Norihiro Nishioka; Satoshi Matsui; Satoshi Yoshimura; Shunsuke Kimata; Shunsuke Kawai; Yuto Makino; Kosuke Kiyohara; Ling Zha; Tetsuhisa Kitamura; Taku Iwami

doi:10.1016/j.resuscitation.2022.06.007

Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka

Resuscitation. 2022 Sep:178:116-123. doi: 10.1016/j.resuscitation.2022.06.007. Epub 2022 Jun 14.

Authors

Yohei Okada¹, Taro Irisawa², Tomoki Yamada³, Kazuhisa Yoshiya⁴, Changhwi Park⁵, Tetsuro Nishimura⁶, Takuya Ishibe⁷, Hitoshi Kobata⁸, Takeyuki Kiguchi⁹, Masafumi Kishimoto¹⁰, Sung-Ho Kim¹¹, Yusuke Ito¹², Taku Sogabe¹³, Takaya Morooka¹⁴, Haruko Sakamoto¹⁵, Keitaro Suzuki¹⁶, Atsunori Onoe¹⁷, Tasuku Matsuyama¹⁸, Daisuke Kobayashi¹⁹, Norihiro Nishioka¹⁹, Satoshi Matsui²⁰, Satoshi Yoshimura¹⁹, Shunsuke Kimata¹⁹, Shunsuke Kawai¹⁹, Yuto Makino¹⁹, Kosuke Kiyohara²¹, Ling Zha²⁰, Tetsuhisa Kitamura²⁰, Taku Iwami²²

Affiliations

¹ Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.
² Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
³ Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan.
⁴ Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan.
⁵ Department of Emergency Medicine, Tane General Hospital, Osaka, Japan.
⁶ Department of Critical Care Medicine, Osaka City University, Osaka, Japan.
⁷ Department of Emergency and Critical Care Medicine, Kindai University, Faculty of Medicine, Osaka-Sayama, Japan.
⁸ Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
⁹ Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan.
¹⁰ Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan.
¹¹ Senshu Trauma and Critical Care Center, Osaka, Japan.
¹² Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan.
¹³ Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁴ Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
¹⁵ Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan.
¹⁶ Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan.
¹⁷ Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
¹⁸ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁹ Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University, Kyoto, Japan.
²⁰ Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
²¹ Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan.
²² Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: iwami.taku.8w@kyoto-u.ac.jp.

PMID: 35714720
DOI: 10.1016/j.resuscitation.2022.06.007

Abstract

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is performed in refractory out-of-hospital cardiac arrest (OHCA) patients, and the eligibility has been conventionally determined based on three criteria (initial cardiac rhythm, time to hospital arrival within 45 minutes, and age <75 years) in Japan. Owing to limited information, this study descriptively determined neurological outcomes after applying the three criteria among OHCA patients who underwent ECPR.

Methods: This study conducted a post-hoc analysis of data from the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study. This was a multi-institutional prospective observational study of OHCA patients in Osaka Prefecture, Japan. All adult (aged ≥18 years) OHCA patients with internal medical causes treated with ECPR between 1 July 2012 and 31 December 2019 were evaluated. We described one-month neurological favourable outcomes based on the three criteria (initial shockable, time to hospital arrival within 45 minutes, and age <75 years), and we compared them using the chi-square test.

Results: Among 18,379 patients screened from the CRITICAL study database, we included 517 OHCA patients treated by ECPR; 311 (60.2%) patients met all three criteria. Favourable neurological outcomes were as follows: patients meeting no or one criterion: 2.3% (1/43), those meeting two criteria: 8% (13/163), and those meeting all criteria: 16.1% (50/311) (P-value = 0.004).

Conclusions: In this study, approximately 60% of patients treated by ECPR met the three criteria (initial shockable, time to hospital arrival within 45 minutes, and age <75 years), and the greater the number of criteria met, the better were the neurological outcomes achieved.

Keywords: ECPR; Out-of-hospital cardiac arrest; SAVE-J study; Ventricular fibrillation.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Cardiopulmonary Resuscitation*
Extracorporeal Membrane Oxygenation*
Humans
Out-of-Hospital Cardiac Arrest*
Prospective Studies
Registries
Retrospective Studies