Impact of mechanical circulatory support on out-of-hospital cardiac arrest outcomes stratified by vasoactive-inotropic score: A retrospective cohort study

Abstract

Aims: To assess whether mechanical circulatory support (MCS), including intra-aortic balloon pump (IABP) or veno-arterial extracorporeal membrane oxygenation (ECMO), can help improve neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA).

Methods: This is a retrospective observational cohort study performed in China Medical University Hospital, Taichung, Taiwan. Adult patients with OHCA admitted between January 2015 and June 2023. Quantitative score of vasoactive-inotropic agents and qualitative interventions of MCS, including IABP and ECMO after OHCA. Multivariate regression evaluated the efficacy of each MCS approach in patients stratified by the vasoactive-inotropic score (VIS).

Results: A total of 334 patients were included and analyzed, 122 (36.5%) had favorable neurological outcomes and 215 (64.4%) survived ≥90 days. These patients were stratified by VIS: 0-25, 26-100, 101-250, and >250. In patients with a VIS > 100, ECMO with or without IABP ensured favorable neurological outcomes and survival after OHCA compared to non-MCS interventions (p < 0.001). For patients with a VIS ≤ 100, IABP alone was beneficial, with no significant outcome difference from non-MCS interventions (p > 0.05).

Conclusions: ECMO with or without IABP therapy may improve post-OHCA neurological outcomes and survival in patients with an expected VIS-24 h > 100 (e.g., epinephrine dose reaches 3 mg during CPR).

Keywords: Extracorporeal membrane oxygenation; Intra-aortic balloon pump; Mechanical circulatory support; Out-of-hospital cardiac arrest; Vasoactive-inotropic score.

Graphical abstract

Fig. 1

Flowchart depicting group allocation. A total of 427 consecutive patients admitted to the cardiac intensive care unit between January 2015 and June 2023 were screened. Patients who had OHCA of a noncardiac origin or metastatic cancer were excluded from the analysis. Eligible patients (n = 334)—adults hospitalized for OHCA of a cardiac origin—were stratified into four groups by the maximum VIS to evaluate ailment severity during the first 24 h after OHCA. The four groups were as follows: patients with a VIS of 0–25, 26–100, 101–250, and >250. Abbreviations: OHCA, out-of-hospital cardiac arrest; VIS, vasoactive-inotropic score.

Fig. 2

Kaplan–Meier curve depicting 90-day survival in patients stratified using the VIS. Patients with a modified VIS-24 h of 0–25: 67/78 (85.9%); 26–100: 65/80 (81.3%); 101–250: 57/95 (60.0%); and >250: 26/81 (32.1%). Log-rank test p < 0.001. Abbreviation: VIS, vasoactive-inotropic score.

Fig. 3

Median VIS for various interventions in patients stratified using the CPC grade. Among patients with a CPC grade 1 or 2 (survival with favorable neurological outcomes), the median VIS was 109.2 for ECMO, 59.9 for IABP therapy, and 24.6 for non-MCS intervention. Among patients with a CPC grade 3 or 4 (survival with poor neurological outcomes), the median VIS was 274.4 for ECMO, 94.5 for IABP therapy, and 80.8 for non-MCS intervention. Abbreviations: CPC, Cerebral Performance Category; ECMO, extracorporeal membrane oxygenation; MCS, mechanical circulatory support; IABP, intra-aortic balloon pump; VIS, vasoactive-inotropic score.