Clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest treated by repeated extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study

Abstract

Aim

Retrospective analysis of clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) requiring extracorporeal membrane oxygenation (ECMO) reinsertion or not.

Methods

Data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in the Japan II database were reviewed. Patients who received ECPR after OHCA between January 2015 and July 2021 and underwent ECPR weaning were divided into reinsertion and no-reinsertion groups. The primary outcome was the 30-day survival rate.

Results

Data from 1011 patients who underwent ECMO weaning ≥1 time and survived were analyzed (12 [1.2%], reinsertion; 999 [98.8%] no-reinsertion). The reinsertion group had a longer time to first ECMO weaning (median [interquartile range, IQR]: 3.0 [2.0–5.0] vs. 4.5 [3.2–6.8] days; p = 0.02). The survival rates at 30 days (25.0% vs. 55.1%; p = 0.08) and favorable neurological outcomes at discharge (8.3% vs. 30.5%; p = 0.18) tended to be lower in the reinsertion group. Among patients who died within 30 days, medical costs were significantly higher in the reinsertion group (median [IQR]: $36,628.2 [26,012.9–45,885.6] vs. $16,456.6 [9341.2–24,880.6]; p < 0.01). Intensive care unit (ICU) stay and mechanical ventilation duration were significantly longer in the reinsertion group.

Conclusion

Patients requiring ECMO reinsertion tended to have poor clinical outcomes and higher healthcare costs, highlighting the need for large-scale studies to develop ECPR protocols and optimize clinical benefits and resource allocation.