Heart rhythm at hospital admission: A factor for survival and neurological outcome among ECPR recipients?
Language English Country Ireland Media print-electronic
Document type Journal Article, Observational Study
PubMed
39424097
DOI
10.1016/j.resuscitation.2024.110412
PII: S0300-9572(24)00306-X
Knihovny.cz E-resources
- Keywords
- Cardiac arrest, Cardiac rhythm, Cardiopulmonary resuscitation, Extracorporeal cardiopulmonary resuscitation, Extracorporeal membrane oxygenation, Heart arrest, Heart rhythm, Rhythm conversion,
- MeSH
- Adult MeSH
- Ventricular Fibrillation therapy mortality complications MeSH
- Hospitalization * statistics & numerical data MeSH
- Cardiopulmonary Resuscitation methods statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * methods statistics & numerical data MeSH
- Survival Rate trends MeSH
- Brain * physiopathology MeSH
- Patient Admission * statistics & numerical data MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Rate * physiology MeSH
- Out-of-Hospital Cardiac Arrest therapy mortality MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
BACKGROUND: The initial rhythm is a known predictor of survival in extracorporeal cardiopulmonary resuscitation (ECPR) patients. However, the effect of the rhythm at hospital admission on outcomes in these patients is less clear. METHODS: This observational, single-center study assessed the influence of the rhythm at hospital admission on 30-day survival and neurological outcomes at discharge in patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA). RESULTS: Between January 2012 and December 2023, 1,219 OHCA patients were admitted, and 210 received ECPR. Of these, 196 patients were analyzed. The average age was 52.9 years (±13), with 80.6 % male. The median time to ECPR initiation was 61 min (IQR 54-72). Patients with ventricular fibrillation as both the initial and admission rhythm had the highest 30-day survival rate (52 %: 35/67), while those with asystole in both instances had the lowest (6 %: 1/17, log-rank p < 0.00001). After adjusting for age, sex, initial rhythm, resuscitation time, location, bystander, and witnessed status, asystole at admission was linked to higher 30-day mortality (OR 4.03, 95 % CI 1.49-12.38, p = 0.009) and worse neurological outcomes (Cerebral Performance Category 3-5) at discharge (OR 4.61, 95 % CI 1.49-17.62, p = 0.013). CONCLUSIONS: The rhythm at hospital admission affects ECPR outcomes. Patients presenting with and maintaining ventricular fibrillation have a higher chance of favorable neurological survival, whereas those presenting with or converting to asystole have poor outcomes. The rhythm at hospital admission appears to be a valuable criterion for deciding on ECPR initiation.
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