Impact of COVID-19 pandemic on out-of-hospital cardiac arrest patients who received extracorporeal pulmonary resuscitation.
The American journal of emergency medicine · 2025-08-25 · Observational study
Abstract
BACKGROUND: The influence of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) patients who received extracorporeal pulmonary resuscitation (ECPR) has not yet been fully elucidated. We examined whether there were differences in ECPR frequency and outcomes for OHCA patients who received ECPR during the pandemic. METHODS: Using the nationwide JAAM-OHCA registry, we evaluated OHCA patients who received ECPR from 2019 to 2022. Since the first state of emergency was declared in April 2020, we compared outcomes for OHCA patients before the pandemic (January 1, 2019 to March 31, 2020) and those during the pandemic (from April 1, 2020 to December 31, 2022). We performed logistic regression analysis adjusted for age, sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, initial/on hospital arrival shockable rhythm, and time from call to extracorporeal membrane oxygenation initiation, as well as interrupted time series analysis (ITSA). The primary outcome was the proportion of 30-day favorable neurological outcomes, defined as Cerebral Performance Category scores of 1-2 between two groups. RESULTS: After excluding patients, 1903 ECPR cases (681 in the pre-pandemic group and 1222 in the pandemic group) were included in the study. ECPR frequency decreased during the pandemic (4.4 % [681/15,344], 45.4 cases per month in the pre-pandemic group, and 3.8 % [1222/32,020], 37.1 cases per month in the pandemic group, odds ratio (OR) 0.86, 95 % confidence interval (CI) 0.78-0.94, p < 0.01). Multivariable logistic regression analysis revealed the COVID-19 pandemic was not associated with 30-day favorable neurological outcomes (12.5 % [85/681] in the pre-pandemic group and 12.6 % [154/1221] in the pandemic group, OR 0.92, 95 % CI 0.67-1.30, p = 0.64). ITSA revealed the frequency of ECPR decreased significantly (-17.2 per month, 95 % CI -26.0--8.5, p < 0.01), while the proportion of 30-day favorable neurological outcomes did not differ (relative risk 1.16, 95 % CI 0.70-1.96, p = 0.56) during the pandemic period. CONCLUSIONS: Although the frequency of ECPR for OHCA patients decreased, prognoses, including favorable neurological outcomes, did not differ during the COVID-19 pandemic.
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Tags
COVID-19 pandemic · ECMO & mechanical circulatory support · Mortality & survival · Quality of life & function
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