The online version of this article (https://doi.org/10.1007/s00134-018-5496-y) contains supplementary material, which is available to authorized users.
Caseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR.
Adult patients who received ECPR in our institution (2006–2016) were classified into groups 1, 2, and 3 (18–65, 65–75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge.
In total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P = 0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of < 30, 30–60, and > 60 min, respectively (P = 0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P = 0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P = 0.274).
On emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome.
Supplement Fig.1: Extracorporeal cardiopulmonary resuscitation case numbers by year and age.Legend: P = 0.961 using the chi-square test(TIFF 3169 kb )134_2018_5496_MOESM1_ESM.tif
Supplement Fig.2: Favorable neurologic outcome (CPC 1, 2) grouped by OHCA and IHCA (TIFF 6509 kb)134_2018_5496_MOESM2_ESM.tif
Supplement material 3 (DOC 34 kb)134_2018_5496_MOESM3_ESM.doc
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