Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study

Tetsuya Sakamoto; Naoto Morimura; Ken Nagao; Yasufumi Asai; Hiroyuki Yokota; Satoshi Nara; Mamoru Hase; Yoshio Tahara; Takahiro Atsumi; Nobuaki Kokubu; Ken Kozuma; Reo Fukuda; Takahiro Ueda; Tadayoshi Miyagi; Isao Takahashi; Mineji Hayakawa; Tomoyuki Endo; Ryouichi Tosa; Takashi Tagami; Taro Mizutani; Susumu Yasuda; Masaki Ano; Takashi Ogino; Kazuya Kiyota; Kazuyuki Ono; Migaku Kikuchi; Hisao Matsushima; Kitamura Shinya; Shunsuke Otani; Kazuhiro Watanabe; Harumi Hirose; Katsunori Sasaki; Yasuhiro Otomo; Yutaka Seki; Makiko Osawa; Munekazu Takeda; Arino Yaguchi; Kentarou Morikawa; Yasufumi Miyake; Masamune Kuno; Katsuhisa Tanjoh; Kosaku Kinoshita; Takao Arai; Kenichirou Kumasaka; Shingo Hori; Masaru Suzuki; Manabu Sugita; Hirokazu Okubo; Jun Sasaki; Yukihiro Watoh; Kiyoshi Matsuda; Tat Suho Kobayashi; Shinji Ogura; Hiroaki Ushikoshi; Shinsuke Ojio; Minoru Maeda; Masahiko Uzura; Hiroaki Higashioka; Terutake Yonemori; Tomonori Hattori; Yoshimi Kitagawa; Shigeki Tsuboi; Hirotaka Tatsukawa; Hirotaka Sawano; Hideki Arimoto; Yasunori Ueda; Kazunori Kashiwase; Minoru Ukikusa; Toshiaki Hamasaki; Shuichi Kozawa; Nobuaki Igarashi; Junya Sato; Noboru Ishii; Akira Takahashi; Kazunari Toyama; Joji Kotani; Masaharu Ishi-hara; Takayuki Otani; Shunji Kasaoka; Makoto Suzuki; Yusuke Yamamoto; Kumpei Osaka; Masaharu Yagi; Shuichi Kobashi; Naoki Momose; Hiroyuki Noguchi; Satoshi Tamashiro; Yoshinori Taka-hashi; Osamu Okawa; Toru Matayoshi; Takahiro Miki; Naoki Kurashima; Ken Magata; Koji Sugawara; Takanori Oshiyama; Keiichi Tojo; Tomio Koyama; Teruyuki Hayashi; Junji Ohhira; Yasuyuki Araki

doi:10.1016/j.resuscitation.2014.01.031

Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study

Tetsuya Sakamoto, Naoto Morimura, Ken Nagao, Yasufumi Asai, Hiroyuki Yokota, Satoshi Nara, Mamoru Hase, Yoshio Tahara, Takahiro Atsumi, Nobuaki Kokubu, Ken Kozuma, Reo Fukuda, Takahiro Ueda, Tadayoshi Miyagi, Isao Takahashi, Mineji Hayakawa, Tomoyuki Endo, Ryouichi Tosa, Takashi Tagami, Taro MizutaniSusumu Yasuda, Masaki Ano, Takashi Ogino, Kazuya Kiyota, Kazuyuki Ono, Migaku Kikuchi, Hisao Matsushima, Kitamura Shinya, Shunsuke Otani, Kazuhiro Watanabe, Harumi Hirose, Katsunori Sasaki, Yasuhiro Otomo, Yutaka Seki, Makiko Osawa, Munekazu Takeda, Arino Yaguchi, Kentarou Morikawa, Yasufumi Miyake, Masamune Kuno, Katsuhisa Tanjoh, Kosaku Kinoshita, Takao Arai, Kenichirou Kumasaka, Shingo Hori, Masaru Suzuki, Manabu Sugita, Hirokazu Okubo, Jun Sasaki, Yukihiro Watoh, Kiyoshi Matsuda, Tat Suho Kobayashi, Shinji Ogura, Hiroaki Ushikoshi, Shinsuke Ojio, Minoru Maeda, Masahiko Uzura, Hiroaki Higashioka, Terutake Yonemori, Tomonori Hattori, Yoshimi Kitagawa, Shigeki Tsuboi, Hirotaka Tatsukawa, Hirotaka Sawano, Hideki Arimoto, Yasunori Ueda, Kazunori Kashiwase, Minoru Ukikusa, Toshiaki Hamasaki, Shuichi Kozawa, Nobuaki Igarashi, Junya Sato, Noboru Ishii, Akira Takahashi, Kazunari Toyama, Joji Kotani, Masaharu Ishi-hara, Takayuki Otani, Shunji Kasaoka, Makoto Suzuki, Yusuke Yamamoto, Kumpei Osaka, Masaharu Yagi, Shuichi Kobashi, Naoki Momose, Hiroyuki Noguchi, Satoshi Tamashiro, Yoshinori Taka-hashi, Osamu Okawa, Toru Matayoshi, Takahiro Miki, Naoki Kurashima, Ken Magata, Koji Sugawara, Takanori Oshiyama, Keiichi Tojo, Tomio Koyama, Teruyuki Hayashi, Junji Ohhira, Yasuyuki Araki

Research output: Contribution to journal › Article › peer-review

364 Citations (Scopus)

Abstract

Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.

Original language	English
Pages (from-to)	762-768
Number of pages	7
Journal	Resuscitation
Volume	85
Issue number	6
DOIs	https://doi.org/10.1016/j.resuscitation.2014.01.031
Publication status	Published - 2014 Jun
Externally published	Yes

Keywords

Advanced life support
Cardiopulmonary resuscitation
Extracorporeal cardiopulmonary resuscitation
Out-of-hospital cardiac arrest
Percutaneous cardiopulmonary support
Ventricular fibrillation

ASJC Scopus subject areas

Emergency Medicine
Emergency
Cardiology and Cardiovascular Medicine

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10.1016/j.resuscitation.2014.01.031

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Sakamoto, T., Morimura, N., Nagao, K., Asai, Y., Yokota, H., Nara, S., Hase, M., Tahara, Y., Atsumi, T., Kokubu, N., Kozuma, K., Fukuda, R., Ueda, T., Miyagi, T., Takahashi, I., Hayakawa, M., Endo, T., Tosa, R., Tagami, T., ... Araki, Y. (2014). Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study. Resuscitation, 85(6), 762-768. https://doi.org/10.1016/j.resuscitation.2014.01.031

Sakamoto, T, Morimura, N, Nagao, K, Asai, Y, Yokota, H, Nara, S, Hase, M, Tahara, Y, Atsumi, T, Kokubu, N, Kozuma, K, Fukuda, R, Ueda, T, Miyagi, T, Takahashi, I, Hayakawa, M, Endo, T, Tosa, R, Tagami, T, Mizutani, T, Yasuda, S, Ano, M, Ogino, T, Kiyota, K, Ono, K, Kikuchi, M, Matsushima, H, Shinya, K, Otani, S, Watanabe, K, Hirose, H, Sasaki, K, Otomo, Y, Seki, Y, Osawa, M, Takeda, M, Yaguchi, A, Morikawa, K, Miyake, Y, Kuno, M, Tanjoh, K, Kinoshita, K, Arai, T, Kumasaka, K, Hori, S, Suzuki, M, Sugita, M, Okubo, H, Sasaki, J, Watoh, Y, Matsuda, K, Kobayashi, TS, Ogura, S, Ushikoshi, H, Ojio, S, Maeda, M, Uzura, M, Higashioka, H, Yonemori, T, Hattori, T, Kitagawa, Y, Tsuboi, S, Tatsukawa, H, Sawano, H, Arimoto, H, Ueda, Y, Kashiwase, K, Ukikusa, M, Hamasaki, T, Kozawa, S, Igarashi, N, Sato, J, Ishii, N, Takahashi, A, Toyama, K, Kotani, J, Ishi-hara, M, Otani, T, Kasaoka, S, Suzuki, M, Yamamoto, Y, Osaka, K, Yagi, M, Kobashi, S, Momose, N, Noguchi, H, Tamashiro, S, Taka-hashi, Y, Okawa, O, Matayoshi, T, Miki, T, Kurashima, N, Magata, K, Sugawara, K, Oshiyama, T, Tojo, K, Koyama, T, Hayashi, T, Ohhira, J & Araki, Y 2014, 'Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study', Resuscitation, vol. 85, no. 6, pp. 762-768. https://doi.org/10.1016/j.resuscitation.2014.01.031

@article{420308489c4249eeb9cfd37916ed7a49,

title = "Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study",

abstract = "Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.",

keywords = "Advanced life support, Cardiopulmonary resuscitation, Extracorporeal cardiopulmonary resuscitation, Out-of-hospital cardiac arrest, Percutaneous cardiopulmonary support, Ventricular fibrillation",

author = "Tetsuya Sakamoto and Naoto Morimura and Ken Nagao and Yasufumi Asai and Hiroyuki Yokota and Satoshi Nara and Mamoru Hase and Yoshio Tahara and Takahiro Atsumi and Nobuaki Kokubu and Ken Kozuma and Reo Fukuda and Takahiro Ueda and Tadayoshi Miyagi and Isao Takahashi and Mineji Hayakawa and Tomoyuki Endo and Ryouichi Tosa and Takashi Tagami and Taro Mizutani and Susumu Yasuda and Masaki Ano and Takashi Ogino and Kazuya Kiyota and Kazuyuki Ono and Migaku Kikuchi and Hisao Matsushima and Kitamura Shinya and Shunsuke Otani and Kazuhiro Watanabe and Harumi Hirose and Katsunori Sasaki and Yasuhiro Otomo and Yutaka Seki and Makiko Osawa and Munekazu Takeda and Arino Yaguchi and Kentarou Morikawa and Yasufumi Miyake and Masamune Kuno and Katsuhisa Tanjoh and Kosaku Kinoshita and Takao Arai and Kenichirou Kumasaka and Shingo Hori and Masaru Suzuki and Manabu Sugita and Hirokazu Okubo and Jun Sasaki and Yukihiro Watoh and Kiyoshi Matsuda and Kobayashi, {Tat Suho} and Shinji Ogura and Hiroaki Ushikoshi and Shinsuke Ojio and Minoru Maeda and Masahiko Uzura and Hiroaki Higashioka and Terutake Yonemori and Tomonori Hattori and Yoshimi Kitagawa and Shigeki Tsuboi and Hirotaka Tatsukawa and Hirotaka Sawano and Hideki Arimoto and Yasunori Ueda and Kazunori Kashiwase and Minoru Ukikusa and Toshiaki Hamasaki and Shuichi Kozawa and Nobuaki Igarashi and Junya Sato and Noboru Ishii and Akira Takahashi and Kazunari Toyama and Joji Kotani and Masaharu Ishi-hara and Takayuki Otani and Shunji Kasaoka and Makoto Suzuki and Yusuke Yamamoto and Kumpei Osaka and Masaharu Yagi and Shuichi Kobashi and Naoki Momose and Hiroyuki Noguchi and Satoshi Tamashiro and Yoshinori Taka-hashi and Osamu Okawa and Toru Matayoshi and Takahiro Miki and Naoki Kurashima and Ken Magata and Koji Sugawara and Takanori Oshiyama and Keiichi Tojo and Tomio Koyama and Teruyuki Hayashi and Junji Ohhira and Yasuyuki Araki",

note = "Funding Information: This study was supported by grants from the Ministry of Health, Labor and Welfare , Japan. ",

year = "2014",

month = jun,

doi = "10.1016/j.resuscitation.2014.01.031",

language = "English",

volume = "85",

pages = "762--768",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

number = "6",

}

TY - JOUR

T1 - Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest

T2 - A prospective observational study

AU - Sakamoto, Tetsuya

AU - Morimura, Naoto

AU - Nagao, Ken

AU - Asai, Yasufumi

AU - Yokota, Hiroyuki

AU - Nara, Satoshi

AU - Hase, Mamoru

AU - Tahara, Yoshio

AU - Atsumi, Takahiro

AU - Kokubu, Nobuaki

AU - Kozuma, Ken

AU - Fukuda, Reo

AU - Ueda, Takahiro

AU - Miyagi, Tadayoshi

AU - Takahashi, Isao

AU - Hayakawa, Mineji

AU - Endo, Tomoyuki

AU - Tosa, Ryouichi

AU - Tagami, Takashi

AU - Mizutani, Taro

AU - Yasuda, Susumu

AU - Ano, Masaki

AU - Ogino, Takashi

AU - Kiyota, Kazuya

AU - Ono, Kazuyuki

AU - Kikuchi, Migaku

AU - Matsushima, Hisao

AU - Shinya, Kitamura

AU - Otani, Shunsuke

AU - Watanabe, Kazuhiro

AU - Hirose, Harumi

AU - Sasaki, Katsunori

AU - Otomo, Yasuhiro

AU - Seki, Yutaka

AU - Osawa, Makiko

AU - Takeda, Munekazu

AU - Yaguchi, Arino

AU - Morikawa, Kentarou

AU - Miyake, Yasufumi

AU - Kuno, Masamune

AU - Tanjoh, Katsuhisa

AU - Kinoshita, Kosaku

AU - Arai, Takao

AU - Kumasaka, Kenichirou

AU - Hori, Shingo

AU - Suzuki, Masaru

AU - Sugita, Manabu

AU - Okubo, Hirokazu

AU - Sasaki, Jun

AU - Watoh, Yukihiro

AU - Matsuda, Kiyoshi

AU - Kobayashi, Tat Suho

AU - Ogura, Shinji

AU - Ushikoshi, Hiroaki

AU - Ojio, Shinsuke

AU - Maeda, Minoru

AU - Uzura, Masahiko

AU - Higashioka, Hiroaki

AU - Yonemori, Terutake

AU - Hattori, Tomonori

AU - Kitagawa, Yoshimi

AU - Tsuboi, Shigeki

AU - Tatsukawa, Hirotaka

AU - Sawano, Hirotaka

AU - Arimoto, Hideki

AU - Ueda, Yasunori

AU - Kashiwase, Kazunori

AU - Ukikusa, Minoru

AU - Hamasaki, Toshiaki

AU - Kozawa, Shuichi

AU - Igarashi, Nobuaki

AU - Sato, Junya

AU - Ishii, Noboru

AU - Takahashi, Akira

AU - Toyama, Kazunari

AU - Kotani, Joji

AU - Ishi-hara, Masaharu

AU - Otani, Takayuki

AU - Kasaoka, Shunji

AU - Suzuki, Makoto

AU - Yamamoto, Yusuke

AU - Osaka, Kumpei

AU - Yagi, Masaharu

AU - Kobashi, Shuichi

AU - Momose, Naoki

AU - Noguchi, Hiroyuki

AU - Tamashiro, Satoshi

AU - Taka-hashi, Yoshinori

AU - Okawa, Osamu

AU - Matayoshi, Toru

AU - Miki, Takahiro

AU - Kurashima, Naoki

AU - Magata, Ken

AU - Sugawara, Koji

AU - Oshiyama, Takanori

AU - Tojo, Keiichi

AU - Koyama, Tomio

AU - Hayashi, Teruyuki

AU - Ohhira, Junji

AU - Araki, Yasuyuki

N1 - Funding Information: This study was supported by grants from the Ministry of Health, Labor and Welfare , Japan.

PY - 2014/6

Y1 - 2014/6

N2 - Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.

AB - Background: A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR).Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. Methods and results: The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P< 0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P= 0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P< 0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P= 0.002), respectively. Conclusions: In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA.

KW - Advanced life support

KW - Cardiopulmonary resuscitation

KW - Extracorporeal cardiopulmonary resuscitation

KW - Out-of-hospital cardiac arrest

KW - Percutaneous cardiopulmonary support

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=84901259752&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901259752&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2014.01.031

DO - 10.1016/j.resuscitation.2014.01.031

M3 - Article

C2 - 24530251

AN - SCOPUS:84901259752

SN - 0300-9572

VL - 85

SP - 762

EP - 768

JO - Resuscitation

JF - Resuscitation

IS - 6

ER -

Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study

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Keywords

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