Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial

被引:1
作者
Ubben, Johannes F. H. [1 ]
Heuts, Samuel [1 ,2 ,3 ]
Delnoij, Thijs S. R. [4 ,5 ]
Suverein, Martje M. [4 ]
Hermanides, Renicus C. [6 ]
Otterspoor, Luuk C. [7 ]
Kraemer, Carlos V. Elzo [8 ]
Vlaar, Alexander P. J. [9 ]
Heijden, Joris J. van der [10 ]
Scholten, Erik [11 ]
den Uil, Corstiaan [12 ,13 ,14 ]
Miranda, Dinis Dos Reis [12 ]
Akin, Sakir [15 ]
de Metz, Jesse [16 ]
Horst, Iwan C. C. [2 ,4 ]
Winkens, Bjorn [17 ,18 ]
Maessen, Jos G. [2 ,3 ]
Lorusso, Roberto [2 ,3 ]
van de Poll, Marcel C. G. [4 ]
机构
[1] MaastrichtUnivers Med Ctr MUMC, Dept Anesthesiol & Pain Med, P Debyelaan 25, NL-6229 HX Maastricht, Netherlands
[2] Maastricht Univ, Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands
[3] Maastricht Univ Med Ctr MUMC, Dept Cardiothorac Surg, Maastricht, Netherlands
[4] Maastricht Univ Med Ctr MUMC, Dept Intens Care Med, Maastricht, Netherlands
[5] Maastricht Univ Med Ctr MUMC, Dept Cardiol, Maastricht, Netherlands
[6] Isala Clin, Dept Cardiol, Zwolle, Netherlands
[7] Catharina Hosp, Dept Intens Care Med, Eindhoven, Netherlands
[8] Leiden Univ, Med Ctr, Dept Intens Care Med, Leiden, Netherlands
[9] Univ Amsterdam, Med Ctr, Dept Intens Care Med, Amsterdam, Netherlands
[10] Univ Med Ctr Utrecht, Dept Intens Care Med, Utrecht, Netherlands
[11] St Antonius Hosp, Dept Intens Care Med, Nieuwegein, Netherlands
[12] Erasmus MC, Dept Intens Care Med, Rotterdam, Netherlands
[13] Maasstad Ziekenhuis, Dept Intens Care Med, Rotterdam, Netherlands
[14] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands
[15] Haga Ziekehuis, Dept Intens Care Med, The Hague, Netherlands
[16] Onze Lieve Vrouw Hosp, Dept Intens Care Med, Amsterdam, Netherlands
[17] Maastricht Univ, Dept Methodol & Stat, Maastricht, Netherlands
[18] Maastricht Univ, Care & Publ Hlth Res Inst CAPHRI, Maastricht, Netherlands
来源
RESUSCITATION PLUS | 2024年 / 18卷
关键词
ECPR; Refractory Arrest; Ventricular Arrhytmias; OHCA; Resuscitation; Prognostic factors; HOSPITAL CARDIAC-ARREST; VENTRICULAR-FIBRILLATION; SURVIVAL; OUTCOMES; SHOCK;
D O I
10.1016/j.resplu.2024.100657
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction : Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a supportive treatment for refractory out -of -hospital cardiac arrest (OHCA). Still, there is a paucity of data evaluating favorable and unfavorable prognostic characteristics in patients considered for ECPR. Methods : We performed a previously unplanned post -hoc analysis of the multicenter randomized controlled INCEPTION -trial. The study group consisted of patients receiving ECPR, irrespective of initial group randomization. The patients were divided into favorable survivors (cerebral performance category [CPC] 1-2) and unfavorable or non -survivors (CPC 3-5). Results : In the initial INCEPTION -trial, 134 patients were randomized. ECPR treatment was started in 46 (66%) of 70 patients in the ECPR treatment arm and 3 (4%) of 74 patients in the conventional treatment arm. No statistically significant differences in baseline characteristics, medical history, or causes of arrest were observed between survivors ( n = 5) and non -survivors ( n = 44). More patients in the surviving group had a shockable rhythm at the time of cannulation (60% vs. 14%, p = 0.037), underwent more defibrillation attempts (13 vs. 6, p = 0.002), and received higher dosages of amiodarone (450 mg vs 375 mg, p = 0.047) despite similar durations of resuscitation maneuvers. Furthermore, non -survivors more frequently had post-ECPR implantation adverse events. Conclusion : The persistence of ventricular arrhythmia is a favorable prognostic factor in patients with refractory OHCA undergoing an ECPR-based treatment. Future studies are warranted to confirm this finding and to establish additional prognostic factors.
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