Extracorporeal vs Conventional Cardiopulmonary Resuscitation in Patients With out-of-Hospital Cardiac Arrest and an Initial Asystole Rhythm.
The Canadian journal of cardiology · 2025-08-05 · Registry study
Abstract
BACKGROUND: There is limited evidence regarding whether extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve clinical outcomes compared with conventional cardiopulmonary resuscitation (CCPR) in patients with out-of-hospital cardiac arrest (OHCA) who have an initial rhythm of asystole. METHODS: Retrospective propensity score-matched analysis of the Japanese Association for Acute Medicine - out-of-hospital cardiac arrest registry was undertaken for adults who suffered OHCA with an initial rhythm of asystole between June 2014 and December 2020 for the primary end point of 30-day survival with favourable neurologic outcome cerebral performance category score 1-2. RESULTS: Propensity score-matching was used to identify 263 pairs in the ECPR and CCPR groups. Survival with favourable neurologic outcome at 30 days was greater in patients with ECPR vs CCPR (4.2% vs 0.8%; P = 0.008) who had OHCA and asystole. Those with severe hypothermia (≤ 28°C) on hospital arrival in the ECPR vs CCPR group also had better 30-day survival with neurologic outcome (20.7% vs 3.6%; P = 0.039). CONCLUSIONS: Although 30-day survival with favourable neurologic outcome was significantly higher in patients with OHCA and asystole with ECPR vs CCPR, the rate was extremely low (< 5%), highlighting the importance of individualized risk-benefit analysis for select consideration of ECPR in this instance (eg, those with severe hypothermia).