Extracorporeal resuscitation restores perfusion and oxygenation in patients without spontaneous circulation. So far, no conclusive evidence has been found regarding the effect of extracorporeal resuscitation on survival, including positive neurological outcomes, in patients who have undergone cardiac arrest outside the walls of the hospital and do not respond to treatment.
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In a study whose findings were published in ‘The New England Journal of Medicine’, the researchers conducted a multicenter, randomized and controlled trial, in which patients who had cardiac arrest outside the hospital were assigned to receive extracorporeal resuscitation or standard resuscitation (advanced cardiac life support). The inclusion criteria were patients between the ages of 18 and 70, who received CPR from bystanders, suffered from a primary ventricular arrhythmia, and did not observe a return to spontaneous heartbeat (ROSC: return of spontaneous circulation) within 15 minutes from the start of CPR. The primary outcome of the study was survival with favorable neurologic outcomes, defined as a Cerebral Performance Category score of 1 or 2 (range 1 to 5, higher scores indicating more severe disability) at 30 days. The researchers conducted analyzes according to the allocation (intention-to-treat).
The random assignment included 160 patients in total, 70 of whom were assigned to receive extracorporeal resuscitation and 64 to receive normal resuscitation; 26 patients who did not meet the inclusion criteria upon arrival at the hospital were excluded. 14 patients (20%) in the extracorporeal resuscitation group were found to be alive with positive neurologic outcomes after 30 days. In contrast, in the standard resuscitation group 10 patients (16%) were found to be alive with positive neurologic outcomes after this period (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P=0.52). The number of serious adverse events per patient was similar between the two groups.
In conclusion, extracorporeal resuscitation and conventional resuscitation led to similar effects on survival with positive neurological outcomes in patients who had out-of-hospital cardiac arrest and did not respond to treatment.
source:
N Engl J Med 2023; 388:299-309 DOI: 10.1056/NEJMoa2204511