The following is a summary of “Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial” published in the October 2022 issue of Critical Care by Rob et al.
With standard advanced cardiac life support, survival rates for out-of-hospital cardiac arrests (OHCA) that don’t get better are still low (ACLS). Extracorporeal cardiopulmonary resuscitation (ECPR), which is when extracorporeal life support (ECLS) is put in while resuscitation is still going on, may increase survival. This study looked at whether ECPR is linked to better results. In the Prague OHCA trial, adults who had been seen to have refractory OHCAs thought to be caused by their hearts took part. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan–Meier estimates and the Cox proportional hazard model was examined.
About 83% of the 256 patients were men with a median age of 58 years and a median length of resuscitation of 52.5 minutes (36.5–68). Of these patients, 83 (32%) achieved prehospital ROSC while receiving conventional ACLS, 81 (32%) did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) did not achieve prehospital ROSC and received ECPR. The overall 180-day survival rate was 51/83 (61.5%) for patients with prehospital ROSC, 1/81 (1.2%) for patients without prehospital ROSC treated with conventional ACLS, and 22/92 (23.9%) for patients without prehospital ROSC treated with ECPR (log-rank P<0.001).
After adjusting for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, and percutaneous coronary intervention status), ECPR was linked to a lower risk of dying within 180 days (HR 0.21, 95% CI 0.14–0.31; P<0.001). In this second look at the randomized refractory OHCA trial, people who didn’t have prehospital ROSC but got ECPR lived longer after 180 days.