Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

Tetsuya Yumoto; Takashi Hongo; Toru Hifumi; Akihiko Inoue; Tetsuya Sakamoto; Yasuhiro Kuroda; Takashi Yorifuji; Atsunori Nakao; Hiromichi Naito; SAVE‐J II study group

doi:10.1002/emp2.12948

Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

J Am Coll Emerg Physicians Open. 2023 Apr 11;4(2):e12948. doi: 10.1002/emp2.12948. eCollection 2023 Apr.

Authors

Tetsuya Yumoto¹, Takashi Hongo¹, Toru Hifumi², Akihiko Inoue³, Tetsuya Sakamoto⁴, Yasuhiro Kuroda⁵, Takashi Yorifuji⁶, Atsunori Nakao¹, Hiromichi Naito¹; SAVE‐J II study group

Affiliations

¹ Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences Okayama University Okayama Kita-ku Okayama Japan.
² Department of Emergency and Critical Care Medicine St. Luke's International Hospital Chuo-ku Tokyo Japan.
³ Department of Emergency, Disaster and Critical Care Medicine Hyogo Emergency Medical Center Chuo-ku Kobe Japan.
⁴ Department of Emergency Medicine Teikyo University School of Medicine Itabashi-Ku Tokyo Japan.
⁵ Department of Emergency, Disaster, and Critical Care Medicine Kagawa University Hospital Miki-cho, Kita-gun Kagawa Japan.
⁶ Department of Epidemiology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences Okayama University Okayama Kita-ku Okayama Japan.

Abstract

Study objective: Early deployment of extracorporeal cardiopulmonary resuscitation (ECPR) is critical in treating refractory out-of-hospital cardiac arrest (OHCA) patients who are potential candidates for ECPR. The effect of prehospital advanced life support (ALS), including epinephrine administration or advanced airway, compared with no ALS in this setting remains unclear. This study's objective was to determine the association between any prehospital ALS care and outcomes of patients who received ECPR with emergency medical services-treated OHCA.

Methods: This was a secondary analysis of data from the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J) II study. Patients were separated into 2 groups-those who received prehospital ALS (ALS group) and those did not receive prehospital ALS (no ALS group). Multiple logistic regression analysis was used to investigate the association between prehospital ALS and favorable neurological outcomes (defined as Cerebral Performance Category scores 1-2) at hospital discharge.

Results: A total of 1289 patients were included, with 644 patients in the ALS group and 645 patients in the no ALS group. There were fewer favorable neurological outcomes at hospital discharge in the ALS group compared with the no ALS group (10.4 vs 19.8%, p <0.001). A multiple logistic regression analysis revealed that any prehospital ALS care (adjusted odds ratios 0.47; 95% confidence interval 0.34-0.66; p <0.001) was associated with unfavorable neurological outcomes at hospital discharge.

Conclusion: Prehospital ALS was associated with worse neurological outcomes at hospital discharge in patients treated with ECPR for OHCA. Further prospective studies are required to determine the clinical implications of these findings.