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

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

• Extracorporeal cardiopulmonary resuscitation
• Neurological outcome
• Out-of-hospital cardiac arrest
• Pupillary reflex
• Body movement
• Gasping