Survey on Japanese emergency physicians' awareness of advanced mechanical circulatory support upgrade therapy for patients with out-of-hospital cardiac arrest receiving extracorporeal cardiopulmonary resuscitation.

Abstract

Destination therapy (DT) using an implantable left ventricular assist device (i-LVAD) in Japan has expanded treatment options for patients with out-of-hospital cardiac arrest (OHCA) receiving extracorporeal cardiopulmonary resuscitation (ECPR). However, achieving hemodynamic stabilization and improved peripheral organ perfusion is essential. In patients with OHCA, percutaneous mechanical circulatory support (MCS) devices may be inadequate in some cases, necessitating surgical MCS. Despite the growing importance of MCS upgrading, awareness among Japanese emergency physicians remains unclear. We aimed to assess awareness of advanced MCS upgrading strategies in refractory patients after ECPR. A nationwide survey of 293 emergency and critical care centers in Japan assessed awareness of i-LVAD therapy after ECPR. The questionnaire collected data on demographics, LVAD strategy recognition, MCS upgrade practices, and barriers. Of 90 facilities (31%) that responded, 87 (30%) consented to using their responses in the analysis. Awareness of DT was 59.8%. Notably, 66.7% and 70.1% of the respondents recognized that MCS upgrading could lead to i-LVAD treatment and heart transplantation, respectively. The major barrier to MCS upgrade therapy was the facility's inability to implement it. DT awareness was similar between IMPELLA-registered and non-registered facilities, but i-LVAD indication recognition was higher in IMPELLA-registered facilities (78.0% vs. 51.4%, P = 0.009). The low survey response rate suggests limited MCS upgrade awareness among Japanese emergency physicians. Although facilities recognize pathways to i-LVAD and transplantation, barriers to their implementation persist. IMPELLA-registered facilities showed higher i-LVAD indication recognition, reflecting their accessibility to LV unloading devices and connections with backup hospitals.