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

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

doi:doi:10.1056/NEJMoa2204511

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...Show moreBACKGROUND
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.)
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Early extracorporeal CPR for refractory out-of-hospital cardiac arrest