Multicenter Study

. 2022 May 9;26(1):129.

doi: 10.1186/s13054-022-03998-y.

Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

Akihiko Inoue^#¹, Toru Hifumi^#², Tetsuya Sakamoto³, Hiroshi Okamoto⁴, Jun Kunikata⁵, Hideto Yokoi⁵, Hirotaka Sawano⁶, Yuko Egawa⁷, Shunichi Kato⁷, Kazuhiro Sugiyama⁸, Naofumi Bunya⁹, Takehiko Kasai⁹, Shinichi Ijuin¹, Shinichi Nakayama¹, Jun Kanda³, Seiya Kanou³, Toru Takiguchi¹⁰, Shoji Yokobori¹⁰, Hiroaki Takada¹¹, Kazushige Inoue¹¹, Ichiro Takeuchi¹², Hiroshi Honzawa¹², Makoto Kobayashi¹³, Tomohiro Hamagami¹³, Wataru Takayama¹⁴, Yasuhiro Otomo¹⁴, Kunihiko Maekawa¹⁵, Takafumi Shimizu¹⁶, Satoshi Nara¹⁶, Michitaka Nasu¹⁷, Kuniko Takahashi¹⁷, Yoshihiro Hagiwara¹⁸, Shigeki Kushimoto¹⁹, Reo Fukuda²⁰, Takayuki Ogura^{18

21}, Shin-Ichiro Shiraishi²², Ryosuke Zushi²³, Norio Otani²⁴, Migaku Kikuchi²⁵, Kazuhiro Watanabe²⁶, Takuo Nakagami²⁷, Tomohisa Shoko²⁸, Nobuya Kitamura²⁹, Takayuki Otani³⁰, Yoshinori Matsuoka³¹, Makoto Aoki³², Masaaki Sakuraya³³, Hideki Arimoto³⁴, Koichiro Homma³⁵, Hiromichi Naito³⁶, Shunichiro Nakao³⁷, Tomoya Okazaki³⁸, Yoshio Tahara³⁹, Yasuhiro Kuroda³⁸; SAVE-J II study group

Collaborators, Affiliations

Collaborators

SAVE-J II study group:
Asae Senda, Hajime Suzuki, Atsunori Tanimoto, Kanta Kitagawa, Yoichi Katayama, Nobuaki Igarashi, Masayuki Kawano, Yuji Kuroki, Tadashi Umehara, Yukari Sasaki, Naoki Tominaga, Takuro Hamaguchi, Takuma Sakai, Takeru Abe, Hiroaki Hanafusa, Yuki Yamaoka, Yumi Kakizaki, Shinya Sakato, Shiho Kashiwabara, Takashi Kadoya, Kayo Misumi, Takaomi Kobayashi, Sou Yamada, Masakazu Kobayashi, Naoko Akashi, Masamune Kuno, Jun Maruyama, Hitoshi Kobata, Mitsuhito Soh, Kasumi Shirasaki, Daiki Shiba, Shutaro Isokawa, Masatoshi Uchida, Atsushi Sakurai, Hirotaka Tatsukawa, Marie Nishikawa, Mitsuaki Kojima, Ryohei Kosaki, Takashi Shimazui, Hiroki Kinoshita, Yusuke Sawada, Ryo Yamamoto, Yuya Masuzawa, Kazuki Matsumura, Junya Shimazaki

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.
² Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. hifumitoru@gmail.com.
³ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁴ Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
⁵ Clinical Research Support Center, Kagawa University Hospital, Kagawa, Japan.
⁶ Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Suita, Japan.
⁷ Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan.
⁸ Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
⁹ Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
¹¹ Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
¹² Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
¹³ Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
¹⁴ Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
¹⁵ Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan.
¹⁶ Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan.
¹⁷ Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan.
¹⁸ Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Tochigi, Japan.
¹⁹ Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
²⁰ Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
²¹ Department of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
²² Department of Emergency and Critical Care Medicine, Aizu Central Hospital, Fukushima, Japan.
²³ Emergency Medicine, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
²⁴ Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
²⁵ Emergency and Critical Care Center, Dokkyo Medical University, Tochigi, Japan.
²⁶ Department of Cardiology, Nihon University Hospital, Tokyo, Japan.
²⁷ Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan.
²⁸ Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
²⁹ Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan.
³⁰ Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
³¹ Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
³² Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
³³ Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Japan.
³⁴ Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
³⁵ Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
³⁶ Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan.
³⁷ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
³⁸ Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan.
³⁹ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

^# Contributed equally.

PMID: 35534870
PMCID: PMC9088043
DOI: 10.1186/s13054-022-03998-y

Multicenter Study

Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

Akihiko Inoue et al. Crit Care. 2022.

. 2022 May 9;26(1):129.

doi: 10.1186/s13054-022-03998-y.

Authors

Collaborators

SAVE-J II study group:
Asae Senda, Hajime Suzuki, Atsunori Tanimoto, Kanta Kitagawa, Yoichi Katayama, Nobuaki Igarashi, Masayuki Kawano, Yuji Kuroki, Tadashi Umehara, Yukari Sasaki, Naoki Tominaga, Takuro Hamaguchi, Takuma Sakai, Takeru Abe, Hiroaki Hanafusa, Yuki Yamaoka, Yumi Kakizaki, Shinya Sakato, Shiho Kashiwabara, Takashi Kadoya, Kayo Misumi, Takaomi Kobayashi, Sou Yamada, Masakazu Kobayashi, Naoko Akashi, Masamune Kuno, Jun Maruyama, Hitoshi Kobata, Mitsuhito Soh, Kasumi Shirasaki, Daiki Shiba, Shutaro Isokawa, Masatoshi Uchida, Atsushi Sakurai, Hirotaka Tatsukawa, Marie Nishikawa, Mitsuaki Kojima, Ryohei Kosaki, Takashi Shimazui, Hiroki Kinoshita, Yusuke Sawada, Ryo Yamamoto, Yuya Masuzawa, Kazuki Matsumura, Junya Shimazaki

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.
² Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. hifumitoru@gmail.com.
³ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁴ Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
⁵ Clinical Research Support Center, Kagawa University Hospital, Kagawa, Japan.
⁶ Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Suita, Japan.
⁷ Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan.
⁸ Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
⁹ Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
¹¹ Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
¹² Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
¹³ Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
¹⁴ Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
¹⁵ Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan.
¹⁶ Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan.
¹⁷ Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan.
¹⁸ Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Tochigi, Japan.
¹⁹ Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
²⁰ Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
²¹ Department of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
²² Department of Emergency and Critical Care Medicine, Aizu Central Hospital, Fukushima, Japan.
²³ Emergency Medicine, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
²⁴ Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
²⁵ Emergency and Critical Care Center, Dokkyo Medical University, Tochigi, Japan.
²⁶ Department of Cardiology, Nihon University Hospital, Tokyo, Japan.
²⁷ Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan.
²⁸ Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
²⁹ Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan.
³⁰ Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
³¹ Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
³² Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
³³ Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Japan.
³⁴ Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
³⁵ Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
³⁶ Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan.
³⁷ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
³⁸ Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan.
³⁹ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

^# Contributed equally.

PMID: 35534870
PMCID: PMC9088043
DOI: 10.1186/s13054-022-03998-y

Abstract

Background: The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications.

Methods: We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2.

Results: A total of 1644 patients with OHCA were included in this study. The patient age was 18-93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45-66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively.

Conclusions: In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.

Keywords: Complication; Extracorporeal cardiopulmonary resuscitation; Neurological outcome; Out-of-hospital cardiac arrest; Real-world data; Survival rate.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Flowchart of enrollment of study participants. ECPR, extracorporeal cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; ROSC, return of spontaneous circulation

**Fig. 2**
Favorable neurological outcome and survival rate at hospital discharge in initial cardiac rhythm. A The proportion of favorable neurological outcome at hospital discharge in initial rhythm at the scene of shockable rhythm, pulseless electrical activity (PEA), and asystole is 16.7%, 9.2%, and 3.9%, respectively. B The survival rate at hospital discharge in initial rhythm at the scene of shockable rhythm, PEA, and asystole is 32.0%, 18.5%, and 10.8%, respectively. A favorable outcome is defined as a cerebral performance category (CPC) of 1 or 2, whereas an unfavorable outcome is defined as a CPC of 3, 4, or 5. Data on initial cardiac rhythm at the scene were missing for 16 patients

**Fig. 3**
Association between age or estimated low flow time and outcomes. A, C Association between age and proportion of favorable outcome and survival rate in all patients and for each initial cardiac rhythm (shockable rhythm, PEA, and asystole). B, D Association between estimated low flow time and proportion of favorable outcome and survival rate in all patients and for each initial cardiac rhythm (shockable rhythm, PEA, and asystole). The bands represent 95% confidence interval (CI). A favorable outcome is defined as a CPC of 1 or 2, whereas an unfavorable outcome is defined as a CPC of 3, 4, or 5

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References

1. Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in adult patients. J Am Heart Assoc. 2020;9(7):e015291. doi: 10.1161/JAHA.119.015291. - DOI - PMC - PubMed
1. Miraglia D, Miguel LA, Alonso W. Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: systematic review and meta-analysis of propensity score-matched cohort studies. J Am Coll Emerg Physicians Open. 2020;1(4):342–361. doi: 10.1002/emp2.12091. - DOI - PMC - PubMed
1. Lunz D, Calabro L, Belliato M, Contri E, Broman LM, Scandroglio AM, et al. Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study. Intensive Care Med. 2020;46(5):973–982. doi: 10.1007/s00134-020-05926-6. - DOI - PubMed
1. Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, et al. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J. 2020;41(21):1961–1971. doi: 10.1093/eurheartj/ehz753. - DOI - PubMed
1. Choi DS, Kim T, Ro YS, Ahn KO, Lee EJ, Hwang SS, et al. Extracorporeal life support and survival after out-of-hospital cardiac arrest in a nationwide registry: a propensity score-matched analysis. Resuscitation. 2016;99:26–32. doi: 10.1016/j.resuscitation.2015.11.013. - DOI - PubMed

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Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

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Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

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