Factors associated with favourable neurological outcomes following cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A retrospective multi-centre cohort study

Naoki Tominaga; Toru Takiguchi; Tomohisa Seki; Takuro Hamaguchi; Jun Nakata; Takeshi Yamamoto; Takashi Tagami; Akihiko Inoue; Toru Hifumi; Tetsuya Sakamoto; Yasuhiro Kuroda; Shoji Yokobori; SAVE-J II study group Investigation Supervision

doi:10.1016/j.resplu.2024.100574

Factors associated with favourable neurological outcomes following cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A retrospective multi-centre cohort study

Resusc Plus. 2024 Feb 8:17:100574. doi: 10.1016/j.resplu.2024.100574. eCollection 2024 Mar.

Affiliations

¹ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
² Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
³ Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan.
⁴ Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, Kobe, Japan.
⁵ Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
⁶ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁷ Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan.

Abstract

Aim: To investigate the factors associated with favourable neurological outcomes in adult patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA).

Methods: This retrospective observational study used secondary analysis of the SAVE-J II multicentre registry data from 36 institutions in Japan. Between 2013 and 2018, 2157 patients with OHCA who underwent ECPR were enrolled in SAVE-J II. A total of 1823 patients met the study inclusion criteria. Adult patients (aged ≥ 18 years) with OHCA, who underwent ECPR before admission to the intensive care unit, were included in our secondary analysis. The primary outcome was a favourable neurological outcome at hospital discharge, defined as a Cerebral Performance Category score of 1 or 2. We used a multivariate logistic regression model to examine the association between factors measured at the incident scene or upon hospital arrival and favourable neurological outcomes.

Results: Multivariable analysis revealed that shockable rhythm at the scene [odds ratio (OR); 2.11; 95% confidence interval (CI), 1.16-3.95] and upon hospital arrival (OR 2.59; 95% CI 1.60-4.30), bystander CPR (OR 1.63; 95% CI 1.03-1.88), body movement during resuscitation (OR 7.10; 95% CI 1.79-32.90), gasping (OR 4.33; 95% CI 2.57-7.28), pupillary reflex on arrival (OR 2.93; 95% CI 1.73-4.95), and male sex (OR 0.43; 95% CI 0.24-0.75) significantly correlated with neurological outcomes.

Conclusions: Shockable rhythm, bystander CPR, body movement during resuscitation, gasping, pupillary reflex, and sex were associated with favourable neurological outcomes in patients with OHCA treated with ECPR.

Keywords: Body movement; Extracorporeal cardiopulmonary resuscitation; Gasping; Neurological outcome; Out-of-hospital cardiac arrest; Pupillary reflex.