Impact of extracorporeal cardiopulmonary resuscitation on outcomes of elderly patients who had out-of-hospital cardiac arrests: a single-centre retrospective analysis

被引:53
作者
Goto, Tadahiro [1 ,2 ]
Morita, Sachiko [2 ]
Kitamura, Tetsuhisa [3 ]
Natsukawa, Tomoaki [2 ]
Sawano, Hirotaka [2 ]
Hayashi, Yasuyuki [2 ]
Kai, Tatsuro [2 ]
机构
[1] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA
[2] Osaka Saiseikai Senri Hosp, Senri Crit Care Med Ctr, Osaka, Japan
[3] Osaka Univ, Grad Sch Med, Dept Social & Environm Med, Div Environm Med & Populat Sci, Osaska, Japan
关键词
LIFE-SUPPORT; ADULTS; GUIDELINES; RESCUE; JAPAN; CARE;
D O I
10.1136/bmjopen-2017-019811
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives Little is known about the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for elderly patients who had out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the impact of age on outcomes among patients who had OHCA treated with ECPR. Design Single-centre retrospective cohort study. Setting A critical care centre that covers a population of approximately 1 million residents. Participants Patients who had consecutive OHCA aged >= 18 years who underwent ECPR from 2005 to 2013. Primary and secondary outcome measures Primary outcomes were 1 month neurologically favourable outcomes and survival. To determine the association between advanced age and each outcome, we fitted multivariable logistic regression models using: (1) age as a continuous variable and (2) age as a categorical variable (<50 years, 50-59 years, 60-69 years and >= 70 years). Results Overall, 144 patients who had OHCA who underwent ECPR were eligible for our analyses. The proportion of neurologically favourable outcomes was 7%, while survival was 19% in patients who had OHCA. After the adjustment for potential confounders, while advanced age was non-significantly associated with neurologically favourable outcomes (adjusted OR 0.96 (95% CI 0.91 to 1.01), p=0.08), the association between advanced age and the poor survival rate was significant (adjusted OR 0.96 (95% Cl 0.93 to 0.99), p=0.04). Additionally, compared with age <50 years, age >= 70 years was non-significantly associated with poor neurological outcomes (adjusted OR 0.08 (95% Cl 0.01 to 1.00), p=0.051), whereas age >= 70 years was significantly associated with worse survival in the adjusted model (adjusted OR 0.14 (95% Cl 0.03 to 0.80), p=0.03). Conclusions In our analysis of consecutive OHCA data from a critical care hospital in an urban area of Japan, we found that advanced age was associated with the lower rate of 1-month survival in patients who had OHCA who underwent ECPR. Although larger studies are required to confirm these results, our findings suggest that ECPR may not be beneficial for patients who had OHCA aged >= 70 years.
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相关论文
共 27 条
[1]  
Ambulance Service Planning Office of Fire and Disaster Management Agency of Japan, EFF 1 AID CARD ARR
[2]  
[Anonymous], 2017, CIRCULATION, V136, pS250
[3]  
Asaka K, 2013, CIRCULATION, V128, pA305
[4]   Extracorporeal cardiopulmonary resuscitation among patients with out-of-hospital cardiac arrest [J].
Choi, Dae-Hee ;
Kim, Youn-Jung ;
Ryoo, Seung Mok ;
Sohn, Chang Hwan ;
Ahn, Shin ;
Seo, Dong-Woo ;
Lim, Ju Yong ;
Kim, Won Young .
CLINICAL AND EXPERIMENTAL EMERGENCY MEDICINE, 2016, 3 (03) :132-138
[5]   Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis [J].
Debaty, Guillaume ;
Babaz, Valentin ;
Durand, Michel ;
Gaide-Chevronnayd, Lucie ;
Fournel, Emmanuel ;
Blancher, Marc ;
Bouvaist, Helene ;
Chavanon, Olivier ;
Maignan, Maxime ;
Bouzat, Pierre ;
Albaladejo, Pierre ;
Labarere, Jose .
RESUSCITATION, 2017, 112 :1-10
[6]   Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis [J].
Devlin, N ;
Parkin, D .
HEALTH ECONOMICS, 2004, 13 (05) :437-452
[7]   Health care costs related to out-of-hospital cardiopulmonary arrest in Japan [J].
Fukuda, Tatsuma ;
Yasunaga, Hideo ;
Horiguchi, Hiromasa ;
Ohe, Kazuhiko ;
Fushimi, Kiyohide ;
Matsubara, Takehiro ;
Yahagi, Naoki .
RESUSCITATION, 2013, 84 (07) :964-969
[8]   Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest [J].
Iwami, Taku ;
Kawamura, Takashi ;
Hiraide, Atsushi ;
Berg, Robert A. ;
Hayashi, Yasuyuki ;
Nishiuchi, Tatsuya ;
Kajino, Kentaro ;
Yonemoto, Naohiro ;
Yukioka, Hidekazu ;
Sugimoto, Hisashi ;
Kakuchi, Hiroyuki ;
Sase, Kazuhiro ;
Yokoyama, Hiroyuki ;
Nonogi, Hiroshi .
CIRCULATION, 2007, 116 (25) :2900-2907
[9]   Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest [J].
Johnson, Nicholas J. ;
Acker, Michael ;
Hsu, Cindy H. ;
Desai, Nimesh ;
Vallabhajosyula, Prashanth ;
Lazar, Sofiane ;
Horak, Jiri ;
Wald, Joyce ;
McCarthy, Fenton ;
Rame, Eduardo ;
Gray, Kathryn ;
Perman, Sarah M. ;
Becker, Lance ;
Cowie, Doreen ;
Grossestreuer, Anne ;
Smith, Tom ;
Gaieski, David F. .
RESUSCITATION, 2014, 85 (11) :1527-1532
[10]   Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support [J].
Kagawa, Eisuke ;
Inoue, Ichiro ;
Kawagoe, Takuji ;
Ishihara, Masaharu ;
Shimatani, Yuji ;
Kurisu, Satoshi ;
Nakama, Yasuharu ;
Dai, Kazuoki ;
Takayuki, Otani ;
Ikenaga, Hiroki ;
Morimoto, Yoshimasa ;
Ejiri, Kentaro ;
Oda, Nozomu .
RESUSCITATION, 2010, 81 (08) :968-973