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

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

Edité par CCSD ; Oxford University Press (OUP) -

International audience. 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.

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