Favorable prognosis by extracorporeal cardiopulmonary resuscitation for subsequent shockable rhythm patients.

Background: Out-of-hospital cardiac arrest (OHCA) patients who convert from an initial non-shockable rhythm to a subsequent shockable rhythm reportedly have a better prognosis for survival than those without rhythm conversion. We evaluated the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for OHCA patients with a subsequent shockable rhythm.

Methods: This study was conducted using the Japanese Association of Acute Medicine OHCA registry. We included OHCA patients with a subsequent shockable rhythm from June 2014 to December 2017. The included patients were divided into those with and without ECPR. The primary outcome was 30-day survival. Logistic regression analysis and propensity score matching were performed to compare the outcomes between patients with and without ECPR.

Results: A total of 2,102 patients were analyzed, consisting of 162 with ECPR and 1,940 without ECPR. Before propensity score matching, 24 (14.8%) patients with ECPR and 61 (3.1%) patients without ECPR survived for 30 days; ECPR was associated with increased survival (P < 0.05; odds ratio [OR], 5.35; 95% confidence interval [CI], 3.09-9.02). After propensity score matching, 22/149 (14.8%) patients with ECPR and 10/149 (6.7%) patients without ECPR survived for 30 days; ECPR was associated with increased survival (P < 0.05; OR, 2.40; 95% CI, 1.04-5.91).

Conclusions: ECPR was associated with increased survival among OHCA patients with a subsequent shockable rhythm.