Impact of staff turnover on extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a nationwide registry-based analysis in Japan

Aim

To evaluate the impact of physician staff turnover on outcomes of out-of-hospital cardiac arrest (OHCA) patients, with a particular focus on those treated with extracorporeal cardiopulmonary resuscitation (ECPR).

Methods

We conducted a nationwide retrospective cohort study using data from the Japanese Association for Acute Medicine OHCA Registry (2014–2022). Adult patients with cardiac arrest upon hospital arrival, including those who received ECPR, were analyzed. Patients were categorized by admission period: late March (18–31 March) and early April (1–14 April), corresponding to the annual physician turnover period in Japan. The primary outcome was 30-day survival. Multivariable logistic regression analysis was performed for both the overall OHCA cohort and the ECPR-treated cohort, adjusting for age, bystander CPR, initial rhythm at hospital arrival, and time from emergency call to hospital arrival.

Results

The final cohort comprised 6036 OHCA patients, of whom 187 received ECPR. In the overall OHCA cohort, no significant difference in 30-day survival was observed between early April and late March. However, among ECPR patients, the 30-day survival rate was significantly higher in early April (36.1 %) than in late March (21.2 %) (p = 0.035), with an adjusted odds ratio of 2.28 (95 % confidence interval: 1.03–5.16; p = 0.044).

Conclusions

While the physician turnover period had no discernible impact on outcomes in the overall OHCA population, it was significantly associated with improved survival among ECPR-treated patients. These findings suggest that ECPR may benefit from institutional preparedness during staff transition, but should be interpreted cautiously given the study limitations.