Early extracorporeal CPR for refractory out-of-hospital cardiac arrest

Author(s):
Suverein, M.M.; Delnoij, T.S.R.; Lorusso, R.; Bruinsma, G.J.B.B.; Otterspoor, L.; Kraemer, C.V.E.; Vlaar, A.P.J.; Heijden, J.J. van der; Scholten, E.; Uil, C. den; Jansen, T.; Bogaard, B. van den; Kuijpers, M.; Lam, K.Y.; Cabezas, J.M.M.; Driessen, A.H.G.; Rittersma, S.Z.H.; Heijnen, B.G.; Miranda, D.D.; Bleeker, G.; Metz, J. de; Hermanides, R.S.; Matta, J.L.; Eberl, S.; Donker, D.W.; Thiel, R.J. van; Akin, S.; Meer, O. van; Henriques, J.; Bokhoven, K.C.; Mandigers, L.; Bunge, J.J.H.; Bol, M.E.; Winkens, B.; Essers, B.; Weerwind, P.W.; Maessen, J.G.; Poll, M.C.G. van de
Published
2023
Publication type
Article / Letter to editor

Abstract

BACKGROUND

Extracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxy-

genation in a patient who does not have spontaneous circulation. The evidence

with regard to the effect of extracorporeal CPR on survival with a favorable neu- rologic outcome in refractory out-of-hospital cardiac arrest is inconclusive. METHODS In this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was sur- vival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis. RESULTS Of the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 pa- tients (20%) in the extracorporeal-CPR group were alive with a favorable neuro- logic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of seri- ous adverse events per patient was similar in the two groups. CONCLUSIONS In patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic out- come. (Funded by the Netherlands Organization for Health Research and Develop- ment and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.)

Date issued
2023-01-26
Language
English
Publisher
Massachusetts Medical Society
Is part of
New England Journal of Medicine (2023), Vol. 388, no. 4, p. 299-309
hdl
1887/3728743
doi
10.1056/NEJMoa2204511
URL
https://www.nejm.org/doi/10.1056/NEJMoa2204511