Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest

Martje M. Suverein*, Thijs S.R. Delnoij, Roberto Lorusso, George J. Brandon Bravo Bruinsma, Luuk Otterspoor, Carlos V. Elzo Kraemer, Alexander P.J. Vlaar, Joris J. Van Der Heijden, Erik Scholten, Corstiaan Den Uil, Tim Jansen, Bas Van Den Bogaard, Marijn Kuijpers, Ka Yan Lam, José M. Montero Cabezas, Antoine H.G. Driessen, Saskia Z.H. Rittersma, Bram G. Heijnen, Dinis Dos Reis Miranda, Gabe BleekerJesse De Metz, Renicus S. Hermanides, Jorge Lopez Matta, Susanne Eberl, Dirk W. Donker, Robert J. Van Thiel, Sakir Akin, Oene Van Meer, José Henriques, Karen C. Bokhoven, Loes Mandigers, Jeroen J.H. Bunge, Martine E. Bol, Bjorn Winkens, Brigitte Essers, Patrick W. Weerwind, Jos G. Maessen, Marcel C.G. Van De Poll

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

134 Citations (Scopus)

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic 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 survival 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 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic 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 serious 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 outcome.

Original languageEnglish
Pages (from-to)299-309
Number of pages11
JournalNew England Journal of Medicine
Volume388
Issue number4
DOIs
Publication statusPublished - 26 Jan 2023

Bibliographical note

Funding Information:
Supported by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary (Getinge).

Publisher Copyright:
© 2023 Massachusetts Medical Society.

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