Transient return of spontaneous circulation related to favourable outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

Takayuki Otani; Toru Hifumi; Akihiko Inoue; Toshikazu Abe; Tetsuya Sakamoto; Yasuhiro Kuroda; SAVE-J II study group

doi:10.1016/j.resplu.2022.100300

Transient return of spontaneous circulation related to favourable outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

Resusc Plus. 2022 Sep 19:12:100300. doi: 10.1016/j.resplu.2022.100300. eCollection 2022 Dec.

Authors

Takayuki Otani¹, Toru Hifumi², Akihiko Inoue³, Toshikazu Abe^{4

5}, Tetsuya Sakamoto⁶, Yasuhiro Kuroda⁷; SAVE-J II study group

Collaborators

SAVE-J II study group:
Hirotaka Sawano, Yuko Egawa, Kazuhiro Sugiyama, Maki Tanabe, Naofumi Bunya, Takehiko Kasai, Shinichi Ijuin, Shinichi Nakayama, Jun Kanda, Seiya Kanou, Toru Takiguchi, Shoji Yokobori, Hiroaki Takada, Kazushige Inoue, Ichiro Takeuchi, Hiroshi Honzawa, Makoto Kobayashi, Tomohiro Hamagami, Wataru Takayama, Yasuhiro Otomo, Kunihiko Maekawa, Takafumi Shimizu, Satoshi Nara, Michitaka Nasu, Kuniko Takahashi, Yoshihiro Hagiwara, Shigeki Kushimoto, Reo Fukuda, Takayuki Ogura, Shin-Ichiro Shiraishi, Ryosuke Zushi, Norio Otani, Migaku Kikuchi, Kazuhiro Watanabe, Takuo Nakagami, Tomohisa Shoko, Nobuya Kitamura, Takayuki Otani, Yoshinori Matsuoka, Makoto Aoki, Masaaki Sakuraya, Hideki Arimoto, Koichiro Homma, Hiromichi Naito, Shunichiro Nakao, Tomoya Okazaki, Yoshio Tahara, Hiroshi Okamoto, Jun Kunikata, Hideto Yokoi

Affiliations

¹ Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-city, Hiroshima 730-8518, Japan.
² Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
³ Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe 651-0073, Japan.
⁴ Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki 300-2622, Japan.
⁵ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan.
⁶ Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan.
⁷ Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.

Abstract

Aim: This study aimed to investigate the relationship between transient return of spontaneous circulation (ROSC) before extracorporeal membrane oxygenation (ECMO) initiation and outcomes in out-of-hospital cardiac arrest (OHCA) patients, who were resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR).

Methods: This study was a secondary analysis of the SAVE-J II study, which was a retrospective multicentre registry study involving 36 participating institutions in Japan. We classified patients into two groups according to the presence or absence of transient ROSC before ECMO initiation. Transient ROSC was defined as any palpable pulse of ≥1 min before ECMO initiation. The primary outcome was favourable neurological outcomes (cerebral performance categories 1-2).

Results: Of 2,157 patients registered in the SAVE-J II study, 1,501 met the study inclusion criteria; 328 (22%) experienced transient ROSC before ECMO initiation. Patients with transient ROSC had better outcomes than those without ROSC (favourable neurological outcome, 26% vs 12%, P < 0.001; survival to hospital discharge, 46% vs 24%, respectively; P < 0.001). A Kaplan-Meier plot showed better survival in the transient ROSC group (log-rank test, P < 0.001). In multiple logistic analyses, transient ROSC was significantly associated with favourable neurological outcomes and survival (favourable neurological outcomes, adjusted odds ratio, 3.34 [95% confidence interval, 2.35-4.73]; survival, adjusted odds ratio, 3.99 [95% confidence interval, 2.95-5.40]).

Conclusions: In OHCA patients resuscitated with ECPR, transient ROSC before ECMO initiation was associated with favourable outcomes. Hence, transient ROSC is a predictor of improved outcomes after ECPR.

Keywords: CI, confidence interval; CPA, cardiopulmonary arrest; CPC, cerebral performance category; CPR, cardiopulmonary resuscitation; ECMO, extracorporeal cardiopulmonary membrane oxygenation; ECPR, extracorporeal cardiopulmonary resuscitation; EMS, emergency medical service; Extracorporeal cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest; OR, odds ratio; Out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; Transient return of spontaneous circulation.