ArticlesCardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis
Introduction
Sudden cardiac arrest still has a low survival rate despite the introduction of cardiopulmonary resuscitation (CPR),1 and this rate has remained unchanged since 1993.2, 3 Investigations have also shown that survival rate declines rapidly when the duration of CPR exceeds 10 min, and even more rapidly if it exceeds 30 min.3, 4, 5
Extracorporeal life-support as a device for cardiac resuscitation was proposed in the early 1960s.6 Advances in technology have allowed such treatment to be deployed rapidly, and several descriptive series investigations have shown encouraging outcomes in patients with cardiac arrest.7, 8, 9 Despite promising results in paediatric patients,10, 11, 12 no comparative data have been assessed in adult groups undergoing CPR assisted with extracorporeal life-support.
Since protracted conventional CPR has been associated with high immediate mortality,4, 5 we did a prospective observational study, between 2004 and 2006, of adults with in-hospital cardiac arrest of cardiac origin who received CPR of more than 10 min. We also aimed to assess whether the survival benefit of extracorporeal CPR over conventional CPR seen in previous studies7, 8, 9 might have been due to selection bias.
Section snippets
Setting
National Taiwan University Hospital, in Taipei, is an extracorporeal life-support referral centre.13, 14, 15 The CPR team consisted of a senior medical resident, several junior residents, a respiratory therapist, a head nurse, and several registered nurses from the intensive care unit. Each member of the CPR team is certified for advanced cardiac life-support. According to American Heart Association guidelines,16 we established an internet-based Utstein style registry system to prospectively
Results
Of the 975 patients with in-hospital cardiac arrest events recorded during the 36-month observational study, 113 received conventional CPR and 59 received extracorporeal CPR, according to the selection criteria (webfigures 1 and 2). The baseline characteristics of both groups are shown in table 1, and CPR and post-CPR variables are shown in table 2. CPR duration did not significantly differ between the two groups (p=0·08). CPR call occurred less frequently in period C (2301 h–0700 h) in the
Discussion
Our observational study focusing on adult in-hospital cardiac arrest of cardiac origin in a single institute has shown a survival benefit in patients receiving extracorporeal CPR compared with those receiving conventional CPR. Although randomisation is, in theory, the proper way to take account of unknown confounders, propensity analysis has still shown a short-term and long-term survival benefit favouring extracorporeal CPR when known confounding factors were matched.
Extracorporeal circulation
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These authors contributed equally