학술논문
Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial
Document Type
article
Author
Johannes F.H. Ubben; Samuel Heuts; Thijs S.R. Delnoij; Martje M. Suverein; Renicus C. Hermanides; Luuk C. Otterspoor; Carlos V. Elzo Kraemer; Alexander P.J. Vlaar; Joris J. van der Heijden; Erik Scholten; Corstiaan den Uil; Dinis Dos Reis Miranda; Sakir Akin; Jesse de Metz; Iwan C.C. van der Horst; Bjorn Winkens; Jos G. Maessen; Roberto Lorusso; Marcel C.G. van de Poll
Source
Resuscitation Plus, Vol 18, Iss , Pp 100657- (2024)
Subject
Language
English
ISSN
2666-5204
Abstract
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a supportive treatment for refractory out-of-hospital cardiac arrest (OHCA). Still, there is a paucity of data evaluating favorable and unfavorable prognostic characteristics in patients considered for ECPR. Methods: We performed a previously unplanned post-hoc analysis of the multicenter randomized controlled INCEPTION-trial. The study group consisted of patients receiving ECPR, irrespective of initial group randomization. The patients were divided into favorable survivors (cerebral performance category [CPC] 1–2) and unfavorable or non-survivors (CPC 3–5). Results: In the initial INCEPTION-trial, 134 patients were randomized. ECPR treatment was started in 46 (66%) of 70 patients in the ECPR treatment arm and 3 (4%) of 74 patients in the conventional treatment arm. No statistically significant differences in baseline characteristics, medical history, or causes of arrest were observed between survivors (n = 5) and non-survivors (n = 44). More patients in the surviving group had a shockable rhythm at the time of cannulation (60% vs. 14%, p = 0.037), underwent more defibrillation attempts (13 vs. 6, p = 0.002), and received higher dosages of amiodarone (450 mg vs 375 mg, p = 0.047) despite similar durations of resuscitation maneuvers. Furthermore, non-survivors more frequently had post-ECPR implantation adverse events. Conclusion: The persistence of ventricular arrhythmia is a favorable prognostic factor in patients with refractory OHCA undergoing an ECPR-based treatment. Future studies are warranted to confirm this finding and to establish additional prognostic factors.Clinical trial Registration: clinicaltrials.gov registration number NCT03101787