Impact of bystander cardiopulmonary resuscitation on neurological outcomes in patients undergoing veno‐arterial extracorporeal membrane oxygenation

Impact of bystander cardiopulmonary resuscitation on neurological outcomes in patients undergoing veno‐arterial extracorporeal membrane oxygenation

Emergency cardiovascular care, Out-of-hospital cardiac arrest, The Glasgow-Pittsburgh Cerebral
Performance and Overall Performance Categories of Brain Function, Intensive care

Background Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) requires a large amount of economic
and human resources. The presence of bystander cardiopulmonary resuscitation (CPR) was focused on selecting
appropriate V-A ECMO candidates.
Result This study retrospectively enrolled 39 patients with V-A ECMO due to out-of-hospital cardiac arrest (CA)
between January 2010 and March 2019. The introduction criteria of V-A ECMO included the following: (1) < 75 years
old, (2) CA on arrival, (3) < 40 min from CA to hospital arrival, (4) shockable rhythm, and (5) good activity of daily living
(ADL). The prescribed introduction criteria were not met by 14 patients, but they were introduced to V-A ECMO at the
discretion of their attending physicians and were also included in the analysis. Neurological prognosis at discharge

was defined using The Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories of Brain Func-
tion (CPC). Patients were divided into good or poor neurological prognosis (CPC ≤ 2 or ≥ 3) groups (8 vs. 31 patients).

The good prognosis group had a significantly larger number of patients who received bystander CPR (p = 0.04). The
mean CPC at discharge was compared based on the combination with the presence of bystander CPR and all five
original criteria. Patients who received bystander CPR and met all original five criteria showed significantly better CPC
than patients who did not receive bystander CPR and did not meet some of the original five criteria (p = 0.046).
Conclusion Considering the presence of bystander CPR help in selecting the appropriate candidate of V-A ECMO
among out-of-hospital CA cases.

Ryosuke Shimai1

, Shohei Ouchi1

, Tetsuro Miyazaki1*, Koji Hirabayashi1

, Hiroshi Abe1

, Kosuke Yabe1
,

Midori Kakihara1

, Masaaki Maki1

, Hiroyuki Isogai1

, Takeshi Wada2
, Dai Ozaki1
, Yuki Yasuda1

, Fuminori Odagiri1
,

Kazuhisa Takamura1

, Kenji Yaginuma1

, Ken Yokoyama1

, Takashi Tokano1 and Tohru Minamino3

https://doi.org/10.1186/s12245-023-00485-1

2023

Peri Irawan

pdf

english

text