ID:47 OA1-2 Prevalence of Deep Coma at Day-3 after Extracorporeal Cardiopulmonary Resuscitation

Background: Although several studies have examined poor neurological outcomes after ECPR, the incidence of patients with severe neurological injury who may progress to brain death following ECPR have been reported in a limited number of studies. The aim of this study was to determine the proportion of patients who develop deep coma without brainstem reflex at 3-day after ECPR. Methods: We conducted a post hoc analysis of the SAVE-J II registry, including adult OHCA patients treated with ECPR at 36 institutions in Japan between 2013 and 2018. The primary outcome was neurological status at day-3 after ECPR. Neurological status was categorized as deep coma without brainstem reflex, non–deep coma without brainstem reflex, or indeterminate due to unavailable medical record information. Deep coma without brainstem reflex was defined using bedside neurological findings documented in medical records: a Glasgow Coma Scale score of 3, bilateral pupil diameter ≥4.0 mm, and absence of pupillary light reflex. Results: A total of 1,961 patients were included. By day-3 after ECPR, 1,065 patients (54.3%) had died. Among the 896 patients who survived to day-3, deep coma without brainstem reflex was observed in 123 patients, corresponding to 13.7% of day-3 survivors and 6.2% of the overall cohort. In contrast, neurological status at day-3 could not be determined from the medical records in 210 patients (10.7% of the overall cohort). Among 123 patients in deep coma without brainstem reflex at day-3, 45 patients (36.6%) had remained as in deep coma without brainstem reflex continuously from ICU admission, whereas 78 patients (63.4%) transitioned to deep coma without brainstem reflex after an initially non–deep coma without brainstem reflex state during the first 3 days. Conclusions: Deep coma without brainstem reflex was observed in 13.7% of 3-day survivors.