Analysis of factors associated with favorable neurological outcomes in patients with initial PEA who underwent ECPR - A secondary analysis of the SAVE-J II study

Purpose: This study aimed to investigate the factors of favorable neurological outcomes in patients with initial pulseless electrical activity (PEA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods: The study analyzed data from the SAVE-J II registry, a retrospective multicenter registry involving 36 participating institutions in Japan. Patients with initial PEA were included. Results: Overall proportion of patients with favorable neurological outcomes and survival rate at hospital discharge were 8.2 % and 16.9 %, respectively. Multivariate analysis revealed that no cardiac rhythm conversion to asystole, signs of life or pupil diameter, and transient return of spontaneous circulation were significantly associated with favorable neurological outcomes. Among the cause of cardiac arrest, patients with acute coronary syndrome and pulmonary embolism had higher proportions of favorable neurological outcomes (9.7 % and 19.3 %), whereas no patients with acute aortic disease or primary cerebral disease survived. The application of strict criteria for PEA using classification and regression tree analysis resulted in favorable neurological outcomes in 32.7 % of the patients. Conclusions: This study provides an overview of patients with PEA who underwent ECPR. Since several factors are associated with favorable neurological outcomes, patients with PEA may be candidates for ECPR if these factors are met.