Cardiac arrest & resuscitation
Neurological outcomes and reperfusion strategies in out-of-hospital cardiac arrest patients due to pulmonary embolism who underwent venoarterial extracorporeal membrane oxygenation: A post-hoc analysis of a multicenter retrospective cohort study
Authors' conclusion
Favorable neurological outcomes were observed in less than 20% of patients with OHCA due to pulmonary embolism undergoing ECMO. Reperfusion strategies may be associated with shorter ECMO durations in these patients.
Study context
- Population
- Out-of-hospital cardiac arrest (OHCA) due to PE treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), 36 institutions in Japan over six years
- Participants
- 78 participants
- Comparison
- Reperfusion strategies vs anticoagulation therapy alone
- Systemic thrombolytic therapyn = 13
- Mechanical reperfusion strategyn = 18
- Primary endpoint
- Favorable neurological outcome (cerebral performance category)
- Follow-up
- Hospital discharge
Methodological details36 institutions in Japan, competing risk model
- 36 institutions in Japan
- Competing risk model
Primary result
As reported in the abstract
Favorable neurological outcome
Favorable neurological outcomes at hospital discharge (all patients)
17.9%
Further findings
| Outcome | sHR (95% CI) | P value | |
|---|---|---|---|
| ECMO separationSystemic thrombolytic therapy vs Anticoagulation therapy alone · adjusted for prespecified covariates, competing risk model | 2.24 (1.21–4.17) | P = 0.011 | |
| ECMO separationMechanical reperfusion strategy vs Anticoagulation therapy alone · adjusted for prespecified covariates, competing risk model | 1.70 (0.86–3.41) | P = 0.129 | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
- ECMO separation — Higher cardiac SOFA score decreased ECMO separation rate (sHR)
- 0.81 (95% CI 0.67-0.97, P = 0.020)
Hospital mortality
- Hospital mortality (all patients)
- 60.3%
ECMO separation
- Approximately half successfully weaned from ECMO
Original publication
Neurological outcomes and reperfusion strategies in out-of-hospital cardiac arrest patients due to pulmonary embolism who underwent venoarterial extracorporeal membrane oxygenation: A post-hoc analysis of a multicenter retrospective cohort study. Resuscitation. Published 5 August 2023. doi:10.
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