Acute cardiac care & resuscitationCohort study
Improved Survival With Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated With Prolonged Resuscitation
- Retrospective cohort study
- consecutive patients
- historical comparison with trial cohort
Authors' conclusion
ECPR was associated with improved neurologically favorable survival at all CPR durations <60 minutes despite severe progressive metabolic derangement. However, CPR duration remains a critical determinate of survival.
Study context
- Population
- Adults with refractory VF/VT OHCA
- Participants
- 160 vs 654
- Exposure
- Extracorporeal cardiopulmonary resuscitation (ECPR) vs standard CPR
- UMN-ECPRn = 160
- ALPSn = 654reference
- Outcome
- Neurologically favorable survival
Main finding
As reported in the abstract
P = 0.01
Observational data: associations, not effects.
Further findings
Mean CPR duration
P < 0.001
| Outcome | UMN-ECPR | ALPS | P value |
|---|---|---|---|
| Neurologically favorable survival, CPR 20 to 29 minutes (subgroup) | 8 of 8 events | 24% |
Neurologically favorable survival by CPR duration
- Significantly higher with UMN-ECPR vs ALPS at each CPR duration interval <60 minutes; progressive decline with longer CPR in both groups
Neurologically favorable survival, prolonged CPR (subgroups)
- UMN-ECPR, CPR 50 to 59 minutes
- 25% (9 of 36)
- UMN-ECPR, CPR ≥60 minutes
- 19%
- ALPS, CPR ≥40 minutes: no neurologically favorable survivors
Mortality or poor neurological function, CPR ≥60 minutes (subgroup)
- RR significantly reduced in UMN-ECPR patients with CPR duration ≥60 minutes
Metabolic changes with prolonged CPR (UMN-ECPR)
- Decline in pH, increased lactic acid and arterial partial pressure of carbon dioxide, thickened LV wall
Original publication
Improved Survival With Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated With Prolonged Resuscitation. Circulation. Published 3 January 2020. doi:10.1161/circulationaha.119.042173
Summarised from the published abstract; every number is checked against it