The Lancet, Volume 372, Issue 9638, Pages 554 - 561, 16 August 2008 <Previous Article|Next Article>doi:10.1016/S0140-6736(08)60958-7Cite or Link Using DOI
Editors' note: Despite more frequent use of cardiopulmonary resuscitation (CPR), sudden cardiac arrest still has a low survival rate. Extracorporeal life-support in cardiac arrest uses a percutaneous system that incorporates the rapid initiation of femoral-femoral venoarterial cardiopulmonary bypass by a trained vascular-access team, followed by the extracorporeal maintenance of circulation until an effective cardiac output has been achieved. In this study, extracorporeal CPR was superior to conventional CPR in terms of short-tem and long-term survival.
Yih-Sharng Chen MD a ‡, Jou-Wei Lin MD d ‡, Hsi-Yu Yu MD a, Wen-Je Ko MD a, Jih-Shuin Jerng MD b, Wei-Tien Chang MD c, Wen-Jone Chen MD b, Shu-Chien Huang MD a, Nai-Hsin Chi MD a, Chih-Hsien Wang MD a, Li-Chin Chen RN b, Pi-Ru Tsai RN a, Sheoi-Shen Wang MD a, Juey-Jen Hwang MD b d, Fang-Yue Lin MD a
Extracorporeal life-support as an adjunct to cardiac resuscitation has shown encouraging outcomes in patients with cardiac arrest. However, there is little evidence about the benefit of the procedure compared with conventional cardiopulmonary resuscitation (CPR), especially when continued for more than 10 min. We aimed to assess whether extracorporeal CPR was better than conventional CPR for patients with in-hospital cardiac arrest of cardiac origin.
We did a 3-year prospective observational study on the use of extracorporeal life-support for patients aged 18-75 years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min compared with patients receiving conventional CPR. A matching process based on propensity-score was done to equalise potential prognostic factors in both groups, and to formulate a balanced 1:1 matched cohort study. The primary endpoint was survival to hospital discharge, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00173615.
Of the 975 patients with in-hospital cardiac arrest events who underwent CPR for longer than 10 min, 113 were enrolled in the conventional CPR group and 59 were enrolled in the extracorporeal CPR group. Unmatched patients who underwent extracorporeal CPR had a higher survival rate to discharge (log-rank p<0·0001) and a better 1-year survival than those who received conventional CPR (log rank p=0·007). Between the propensity-score matched groups, there was still a significant difference in survival to discharge (hazard ratio [HR] 0·51, 95% CI 0·35-0·74, p<0·0001), 30-day survival (HR 0·47, 95% CI 0·28-0·77, p=0·003), and 1-year survival (HR 0·53, 95% CI 0·33-0·83, p=0·006) favouring extracorporeal CPR over conventional CPR.
Extracorporeal CPR had a short-term and long-term survival benefit over conventional CPR in patients with in-hospital cardiac arrest of cardiac origin.
National Science Council, Taiwan.