Long-term health-related quality of life in survivors of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation- A cohort study using Australian and New Zealand extracorporeal membrane oxygenation registry and the Victorian Ambulance Cardiac Arrest Registry

Abstract

Aim: To compare the long-term health-related quality of life (HRQoL) between patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) for out-of-hospital cardiac arrest (OHCA).

Methods and settings: A retrospective cohort study using the Australian and New Zealand extracorporeal membrane oxygenation (EXCEL) registry for ECPR cases and the Victorian Ambulance Cardiac Arrest Registry (VACAR) for CCPR cases. All the adult patients with OHCA who had their cardiac arrest and 12-month HRQoL data recorded between July 2019 and July 2023 were eligible for inclusion. The primary outcomes were the 12-month EuroQol five-dimension (EQ-5D-5L) utility score and EuroQol visual analogue score (EQ-VAS).

Results: There were 33/122(28%) ECPR and 1,074/8,990(12%) CCPR OHCA survivors at 12 months. Of these, 24 (73%) ECPR and 754 (70%) CCPR survivors had HRQoL data. The ECPR cohort was younger [mean(SD) 50.4(13.46) vs 60.5(14.01) yrs, p < 0.01] and more likely to have received bystander CPR [19(79%) ECPR vs 397(52%) CCPR, p < 0.001]. Both cohorts had similar proportions of males, witnessed arrests and initial shockable rhythms. Median (IQR) arrest to ROSC/ECMO time was longer in ECPR than CCPR [61(41.5-97) vs 6(2-14) minutes, p < 0.001]. The median (IQR) EQ-5D-5L utility score [0.95 (0.72-1) ECPR vs 0.96 (0.86-1) CCPR, p = 0.64] and median (IQR) EQ-VAS at 12 months [80 (64.5-90) ECPR vs 75 (60-85) CCPR, p = 0.39] were similar. There were no significant differences in the EQ-5D-5L utility scores and EQ-VAS even after adjustment for baseline imbalances.

Conclusions: Despite significant baseline differences between ECPR and CCPR, there were no differences in HRQoL at 12 months.

Keywords: Cardiopulmonary resuscitation; Cognitive function; Extracorporeal cardiopulmonary resuscitation; Health-related quality of life; Out-of-hospital cardiac arrest.