Portal de Periódicos da CAPES

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

2019; Oxford University Press; Volume: 41; Issue: 21 Linguagem: Inglês

10.1093/eurheartj/ehz753

1522-9645

Wulfran Bougouin, Florence Dumas, Lionel Lamhaut, Éloi Marijon, Pierre Carli, Alain Combes, Romain Pirracchio, Nadia Aïssaoui, Nicole Karam, Nicolas Deye, Georgios Sidéris, Frankie Beganton, Daniel Jost, Alain Cariou, Xavier Jouven, Frédéric Adnet, Jean‐Marc Agostinucci, N. Aissaoui-Balanant, Vincent Algalarrondo, François Alla, Christine Alonso, W. Amara, Djillali Annane, C. Antoine, P Aubry, Élie Azoulay, Frankie Beganton, D. Benhamou, Clarisse Billon, Wulfran Bougouin, J. Boutet, Cédric Bruel, Patrick Bruneval, Alain Cariou, Pierre Carli, Enrique Casalino, Charles Cerf, A. Chaïb, Bernard Cholley, Yves Cohen, Alain Combes, Marie Crahès, D Da Silva, Vijay Kumar Das, Alexandre Demoule, Isabelle Denjoy, Nicolas Deye, G. Dhonneur, Jean‐Luc Diehl, S. Dinanian, Leszek Domański, Didier Dreyfuss, D Duboc, J L Dubois-Randé, Florence Dumas, Jean‐Philippe Empana, Fabrice Extramiana, Muriel Fartoukh, Fabienne Fieux, Marco Gabbas, Estelle Gandjbakhch, Guillaume Géri, Bertrand Guidet, Franck Halimi, P. Henry, F. Hidden Lucet, P. Jabre, Line Jacob, Lee Joseph, Daniel Jost, Xavier Jouven, Nicole Karam, H. Kassim, Jèrôme Lacotte, Khadija Lahlou‐Laforêt, Lionel Lamhaut, A. Lanceleur, Olivier Langeron, Thomas Lavergne, Éric Lecarpentier, Antoine Leenhardt, Nicolas Lellouche, Virginie Lemiale, F. Lemoine, F. Linval, Thomas Loeb, Bertrand Ludes, Charles‐Édouard Luyt, Alice Maltret, Nicolas Mansencal, Nadia Mansouri, Éloi Marijon, J. Marty, Éric Maury, Virginie Maxime, Bruno Mégarbane, Armand Mekontso Dessap, Hervé Mentec, Jean Paul Mira, Xavier Monnet, Kumar Narayanan, N. Ngoyi, M C Perier, Olivier Piot, Romain Pirracchio, Patrick Plaisance, Isabelle Plu, Mathieu Raux, François Revaux, Jean-Damien Ricard, Christian Richard, Bruno Riou, France Roussin, F. Santoli, Frédérique Schortgen, Ardalan Sharifzadehgan, Georgios Sidéris, Christian Spaulding, Jean–Louis Teboul, J-F. Timsit, J.-P. Tourtier, Philippe Tuppin, C. Ursat, Olivier Varenne, Antoine Vieillard‐Baron, Sébastian Voicu, Karim Wahbi, Victor Waldmann,

Cardiac Structural Anomalies and Repair

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.