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. 2024 May 13:18:100657.
doi: 10.1016/j.resplu.2024.100657. eCollection 2024 Jun.

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

Johannes F H Ubben  1 , Samuel Heuts  2   3 , Thijs S R Delnoij  4   5 , Martje M Suverein  4 , Renicus C Hermanides  6 , Luuk C Otterspoor  7 , Carlos V Elzo Kraemer  8 , Alexander P J Vlaar  9 , Joris J van der Heijden  10 , Erik Scholten  11 , Corstiaan den Uil  12   13   14 , Dinis Dos Reis Miranda  12 , Sakir Akin  15 , Jesse de Metz  16 , Iwan C C van der Horst  2   4 , Bjorn Winkens  17   18 , Jos G Maessen  2   3 , Roberto Lorusso  2   3 , Marcel C G van de Poll  4   19   20
Affiliations

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

Johannes F H Ubben et al. Resusc Plus. .

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 registration number NCT03101787.

Keywords: ECPR; OHCA; Prognostic factors; Refractory Arrest; Resuscitation; Ventricular Arrhytmias.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Roberto Lorusso reports consulting fees from Medtronic, LivaNova, Getinge, and Abiomed and participates in an advisory board of Eurosets and Xenios, which are not related to this work. All other authors report no conflicts of interest.’.

Figures

Fig. 1
Fig. 1
Flowchart for patient inclusion in this secondary analysis of the INCEPTION-trial.
See this image and copyright information in PMC

References

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