Prognostic Significance of Signs of Life in Out-of-Hospital Cardiac Arrest Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
03 Nov 2023
03 Nov 2023
Historique:
medline:
3
11
2023
pubmed:
3
11
2023
entrez:
3
11
2023
Statut:
aheadofprint
Résumé
Signs of life (SOLs) during cardiac arrest (gasping, pupillary light reaction, or any form of body movement) are suggested to be associated with favorable neurologic outcomes in out-of-hospital cardiac arrest (OHCA). While data has demonstrated that extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes in cases of refractory cardiac arrest, it is expected that other contributing factors lead to positive outcomes. This study aimed to investigate whether SOL on arrival is associated with neurologic outcomes in patients with OHCA who have undergone ECPR. Retrospective multicenter registry study. Thirty-six facilities participating in the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan II (SAVE-J II). Consecutive patients older than 18 years old who were admitted to the Emergency Department with OHCA between January 1, 2013, and December 31, 2018, and received ECPR. None. Patients were classified into two groups according to the presence or absence of SOL on arrival. The primary outcome was a favorable neurologic outcome (Cerebral Performance Category 1 or 2) at discharge. Of the 2157 patients registered in the SAVE-J II database, 1395 met the inclusion criteria, and 250 (17.9%) had SOL upon arrival. Patients with SOL had more favorable neurologic outcomes than those without SOL (38.0% vs. 8.1%; p < 0.001). Multivariate analysis showed that SOL on arrival was independently associated with favorable neurologic outcomes (odds ratio, 5.65 [95% CI, 3.97-8.03]; p < 0.001). SOL on arrival was associated with favorable neurologic outcomes in patients with OHCA undergoing ECPR. In patients considered for ECPR, the presence of SOL on arrival can assist the decision to perform ECPR.
Identifiants
pubmed: 37921512
doi: 10.1097/CCM.0000000000006116
pii: 00003246-990000000-00225
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Hiroshi Okamoto
(H)
Jun Kunikata
(J)
Hideto Yokoi
(H)
Hirotaka Sawano
(H)
Yuko Egawa
(Y)
Shunichi Kato
(S)
Kazuhiro Sugiyama
(K)
Shinichi Nakayama
(S)
Jun Kanda
(J)
Seiya Kanou
(S)
Toru Takiguchi
(T)
Shoji Yokobori
(S)
Hiroaki Takada
(H)
Kazushige Inoue
(K)
Ichiro Takeuchi
(I)
Hiroshi Honzawa
(H)
Makoto Kobayashi
(M)
Tomohiro Hamagami
(T)
Wataru Takayama
(W)
Yasuhiro Otomo
(Y)
Kunihiko Maekawa
(K)
Takafumi Shimizu
(T)
Michitaka Nasu
(M)
Kuniko Takahashi
(K)
Yoshihiro Hagiwara
(Y)
Shigeki Kushimoto
(S)
Reo Fukuda
(R)
Takayuki Ogura
(T)
Shin-Ichiro Shiraishi
(SI)
Ryosuke Zushi
(R)
Norio Otani
(N)
Migaku Kikuchi
(M)
Kazuhiro Watanabe
(K)
Takuo Nakagami
(T)
Tomohisa Shoko
(T)
Nobuya Kitamura
(N)
Takayuki Otani
(T)
Yoshinori Matsuoka
(Y)
Makoto Aoki
(M)
Masaaki Sakuraya
(M)
Hideki Arimoto
(H)
Koichiro Homma
(K)
Hiromichi Naito
(H)
Shunichiro Nakao
(S)
Tomoya Okazaki
(T)
Yoshio Tahara
(Y)
Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
The authors have disclosed that they do not have any potential conflicts of interest.
Références
Soar J, Maconochie I, Wyckoff MH, et al.: 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2019; 145:95–150
Richardson ASC, Tonna JE, Nanjayya V, et al.: Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus statement from the Extracorporeal Life Support Organization. ASAIO J 2021; 67:221–228
Suverein MM, Delnoij TSR, Lorusso R, et al.: Early extracorporeal CPR for refractory out-of-hospital cardiac arrest. N Engl J Med 2023; 388:299–309
Belohlavek J, Smalcova J, Rob D, et al.; Prague OHCA Study Group: Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest: A randomized clinical trial. JAMA 2022; 327:737–747
Yannopoulos D, Bartos J, Raveendran G, et al.: Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): A phase 2, single centre, open-label, randomised controlled trial. Lancet 2020; 396:1807–1816
Sakamoto T, Morimura N, Nagao K, et al.; SAVE-J Study Group: Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study. Resuscitation 2014; 85:762–768
Debaty G, Babaz V, Durand M, et al.: Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation 2017; 112:1–10
Junhong W, Qingbian M, Hua Z, et al.: Predictors of survival and neurologic outcome for adults with extracorporeal cardiopulmonary resuscitation: A systemic review and meta-analysis. Medicine (Baltim) 2018; 97:e13257
Murakami N, Kokubu N, Nagano N, et al.: Prognostic impact of no-flow time on 30-day neurological outcomes in patients with out-of-hospital cardiac arrest who received extracorporeal cardiopulmonary resuscitation. Circ J 2020; 84:1097–1104
Otani T, Sawano H, Natsukawa T, et al.: Low-flow time is associated with a favorable neurological outcome in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation. J Crit Care 2018; 48:15–20
Wengenmayer T, Rombach S, Ramshorn F, et al.: Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care 2017; 21:157
Debaty G, Labarere J, Frascone RJ, et al.: Long-term prognostic value of gasping during out-of-hospital cardiac arrest. J Am Coll Cardiol 2017; 70:1467–1476
Steen-Hansen JE, Hansen NN, Vaagenes P, et al.: Pupil size and light reactivity during cardiopulmonary resuscitation: A clinical study. Crit Care Med 1988; 16:69–70
Olaussen A, Nehme Z, Shepherd M, et al.: Consciousness induced during cardiopulmonary resuscitation: An observational study. Resuscitation 2017; 113:44–50
Hoeyweghen RV, Mullie A, Bossaert L: Decision making to cease or to continue cardiopulmonary resuscitation (CPR). The cerebral resuscitation study group. Resuscitation 1989; 17:S137–S147
Debaty G, Lamhaut L, Aubert R, et al.: Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest. Resuscitation 2021; 162:163–170
Inoue A, Hifumi T, Sakamoto T, et al.; SAVE-J II study group: Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: A retrospective large cohort multicenter study in Japan. Crit Care 2022; 26:129
Study of Advanced Cardiac Life Support for Ventricular Fibrillation With Extracorporeal Circulation in Japan. Available at: https://upload.umin.ac.jp/cgi‑open‑bin/ctr/ctr_view.cgi?recptno=R000041577. Accessed January 7, 2022
Cummins RO, Chamberlain DA, Abramson NS, et al.: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The Utstein style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991; 84:960–975
Bunya N, Ohnishi H, Wada K, et al.: Gasping during refractory out-of-hospital cardiac arrest is a prognostic marker for favourable neurological outcome following extracorporeal cardiopulmonary resuscitation: A retrospective study. Ann Intensive Care 2020; 10:112
D’Arrigo S, Cacciola S, Dennis M, et al.: Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis. Resuscitation 2017; 121:62–70
Pozzi M, Koffel C, Armoiry X, et al.: Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience. Int J Cardiol 2016; 204:70–76
Tonna JE, Selzman CH, Girotra S, et al.; American Heart Association Get With the Guidelines–Resuscitation Investigators: Resuscitation using ECPR during in-hospital cardiac arrest (RESCUE-IHCA) mortality prediction score and external validation. JACC Cardiovasc Interv 2022; 15:237–247
Bunya N, Wada K, Yamaoka A, et al.: The prognostic value of agonal respiration in refractory cardiac arrest: A case series of non-shockable cardiac arrest successfully resuscitated through extracorporeal cardiopulmonary resuscitation. Acute Med Surg 2019; 6:197–200