Characteristics of Intracranial Hemorrhage and Acute Aortic Syndromes Resuscitated with Extracorporeal Cardiopulmonary Resuscitation (ECPR)

Background

Intracranial hemorrhage (ICH) and acute aortic syndrome (AAS) are etiologies associated with unfavorable outcomes in patients with out-of-hospital cardiac arrest (OHCA), even with extracorporeal cardiopulmonary resuscitation (ECPR).

Objectives

This study aimed to describe the characteristics of refractory OHCA patients resuscitated with ECPR due to ICH and AAS.

Methods

This was a descriptive study and a secondary analysis of the SAVE-J II study, which was a multicenter ECPR registry.

Results

Among the 1589 cases, the causes of arrest were ICH in 48 patients (3%), AAS in 112 patients (7%), and cardiac causes in 1429 patients (90%). Patients in the ICH group were younger (ICH: 47 years [interquartile ranges (IQR) 40–63], AAS: 68 years [IQR 59–74], cardiac causes: 61 years [IQR 50–68]; p < 0.001), and had fewer signs of life on hospital arrival (ICH: 2%, AAS: 12%, cardiac causes: 19%; p = 0.001) compared to the cardiac causes group. Patients in the ICH and AAS groups were also less likely to present with an initial shockable rhythm (ICH, 19%; AAS, 27%; cardiac causes, 74%; p < 0.001). Survival to hospital discharge was significantly lower in the ICH and AAS groups than in the cardiac cause group (ICH, 4%; AAS, 4%; cardiac causes, 29%; p < 0.001). Of the 112 patients in the AAS group, 54 (48%) were presumptively diagnosed as cardiac etiologies before ECPR.

Conclusion

ICH and AAS should be considered potential causes of cardiac arrest, especially in cases with a nonshockable initial cardiac rhythm. However, differentiating them from cardiac causes of arrest remains challenging.