Background: Extracorporeal cardiopulmonary resuscitation (ECPR) uses extracorporeal circulation, such as veno-arterial extracorporeal membrane oxygenation (V-A ECMO), during cardiac arrest. Although the Japanese Resuscitation Council Guidelines 2020 provide only a weak recommendation for ECPR, recent studies, including the ARREST trial, have reported favorable outcomes. We investigated prognostic factors in out-of-hospital cardiac arrest (OHCA) patients treated with ECPR at our institution. Methods: This retrospective observational study included OHCA patients transported to St. Marianna University Hospital between January 1, 2011, and September 30, 2024, who underwent ECPR with V-A ECMO combined with intra-aortic balloon pumping (IABP) or a microaxial pump catheter (Impella®). Clinical characteristics and outcomes were analyzed, and predictors of favorable neurological outcome were evaluated using receiver operating characteristic (ROC) curve analysis. Results: A total of 69 patients were included; the median age was 58.0 50.5–66.0 years, and 62 patients were male. Survival rates were 36.2% at 30 days (25 patients) and 23.2% at 90 days (16 patients). Favorable neurological outcome at 90 days, defined as Cerebral Performance Category (CPC) 1–2, was observed in 10 patients (14.9%). The time from emergency medical service (EMS) recognition to initiation of ECMO at our hospital predicted favorable neurological outcome, with an area under the ROC curve of 0.76. A cutoff value of 50 minutes yielded a sensitivity of 83.3% and specificity of 70.5%. Conclusion: In OHCA patients treated with ECPR at our institution, initiation of ECMO within 50 minutes from EMS recognition was associated with a favorable neurological outcome at 90 days.
Inoue et al. (Mon,) studied this question.
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