Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial

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

*Corresponding author for this work

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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

Original languageEnglish
Article number100657
JournalResuscitation Plus
Volume18
DOIs
Publication statusPublished - Jun 2024

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