Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest
Martje M. Suverein, Thijs Delnoij, Roberto Lorusso, George J. Brandon Bravo Bruinsma, Luuk Otterspoor, Carlos V. Elzo Kraemer, Alexander P. J. Vlaar, Joris van der Heijden, Erik Scholten, Corstiaan A. den Uil, T. Jansen, Bas van den Bogaard, Marijn Kuijpers, Ka Yan Lam, José M. Montero Cabezas, Antoine H.G. Driessen, Saskia Z.H. Rittersma, Bram G. Heijnen, Dinís Dos Reis Miranda, Gabe B. Bleeker, Jesse de Metz, Renicus S. Hermanides, Jorge López Matta, Susanne Eberl, Dirk W. Donker, Robert J. van Thiel, Şakir Akın, Oene van Meer, Josè P.S. Henriques, Karen C. Bokhoven, Loes Mandigers, Jeroen J. H. Bunge, Martine E. Bol, Björn Winkens, Brigitte A.B. Essers, Patrick W. Weerwind, Jos G. Maessen, Marcel C.G. van de Poll
Abstract
BACKGROUND: Extracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest is inconclusive. METHODS: In this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis. RESULTS: Of the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of serious adverse events per patient was similar in the two groups. CONCLUSIONS: In patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome. (Funded by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.).