Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest: A propensity score matching, observational study

Abstract

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly performed as an adjunct to conventional cardiopulmonary resuscitation (CCPR) for out-of-hospital cardiac arrest (OHCA). However, the specific benefits of ECPR concerning survival with favorable neurological outcomes remain uncertain. This study aimed to investigate the comparative advantages of ECPR over CCPR in the management of OHCA. We conducted a retrospective cohort study as a single center involved OHCA patients between January 2016 and May 2021. Patients were categorized into ECPR or CCPR groups. The primary endpoint assessed was survival with favorable neurological outcomes, and the secondary outcome was survival rate. Multivariate logistic regression analyses, with and without 1:4 propensity score matching (PSM), were employed to assess ECPR’s effect. In total, 1792 patients were included: 111 underwent ECPR, and 1681 received CCPR. Compared to the CCPR group, the ECPR group exhibited notably higher rates of sustained return of spontaneous circulation (ROSC) (93.7% vs. 27.7%; p < 0.001), survival to discharge (38.7% vs. 13.9%; p < 0.001), and survival with favorable neurological outcome (22.5% vs. 6.0%; p < 0.001). Multivariate logistic regression analysis demonstrated that ECPR correlated with increased odds of survival with favorable neurological outcome (adjusted odds ratio: 1.79; 95% confidence interval (CI): 1.03–3.11; p < 0.037). Following PSM, the ECPR group showed significantly elevated odds of survival with favorable neurological outcomes (adjusted odds ratio: 2.22; 95% CI: 1.20–4.11; p = 0.010). This study demonstrated that in comparison to CCPR, ECPR may improve survival rates and odds of favorable neurological outcomes in OHCA patients.