Risk factors and outcome of extracorporeal cardiopulmonary resuscitation patients with out-of-hospital cardiac arrest and in-hospital cardiac arrest: a nationwide prospective and observational study of 939 hospitals in China.

Abstract

Background: Sudden cardiac arrest represents a global health challenge characterized by high mortality and morbidity rates. Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly considered as an effective treatment for cardiac arrest; however, its application remains a subject of debate. Furthermore, limited studies have analysed out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) populations within the same context.

Methods: This study involved the selection of patients who experienced cardiac arrests and were supported by ECPR in 939 tertiary hospitals across 31 provinces between 2016 and 2021. The data was derived from the ECMO Quality Improvement Project.

Results: Among the 939 tertiary hospitals, a total of 6374 patients who had cardiac arrest events were identified, categorized as OHCA (1465) and IHCA (4909). Survivors in the IHCA group were comparatively younger (50 [IQR: 33-62] vs. 53 [IQR: 38-64], p < 0.001) and more likely to be female (34.2% vs. 29.8%, p < 0.05), while in the OHCA group, survivor characteristics remained similar. Multivariable modelling indicated that in the IHCA group, age ≥ 60, regions with lower GDP, acute respiratory distress syndrome (ARDS), sepsis, electrolyte disturbance, hypertension, acute renal failure, and disseminated intravascular coagulation (DIC) were identified as independent risk factors associated with hospital mortality. Conversely, being female, experiencing arrhythmia, myocarditis, and acute heart failure were identified as protective factors. In the OHCA group, independent risk factors included regions with lower GDP, hypertension, and DIC, while arrhythmia, myocarditis, ARDS, and acute heart failure were protective factors.

Conclusions: This nationwide prospective observational study provides insights into the utilization of ECPR among patients experiencing OHCA and IHCA. It also underscores the disparity in risk factors and outcomes between OHCA and IHCA populations, indicating differences in clinical practices. Notably, DIC is recognized as a risk factor associated with mortality. Although the exact mechanism remains unclear, it is recommended as a screening indicator for risk stratification.

Clinical trial number: Not applicable.