(226) ECPR Versus CCPR: Expanding the Therapeutic Window in Out-of-Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promising potential in improving the prognosis for patients suffering from prolonged out-of-hospital cardiac arrest (OHCA) who remain resistant to conventional cardiopulmonary resuscitation (CCPR). However, no controlled trials have investigated the extent of the effective time window extension provided by ECPR compared to CCPR to achieve a favorable neurological prognosis.

Methods: We conducted a retrospective analysis of data derived from the Japanese Association for Acute Medicine (JAAM)-OHCA Registry, a nationwide, multicenter prospective database in Japan, from 2014 to 2019. The study included OHCA patients of cardiac origin, aged 18 years or older, with a cardiac arrest time between 21 and 120 minutes. The primary outcome was survival with favorable neurological function at one month, defined by a Cerebral Performance Category score of 1 or 2. We employed a multivariate logistic regression analysis with a non-linear restricted cubic spline and plotted the adjusted outcome probability against cardiac arrest time. The critical time point was defined as the time at which the lower limit of the confidence interval for the predicted probability fell below 1%.

Results: Of the 20,286 eligible patients, 1,201 received ECPR, and 19,085 received CCPR. One month after cardiac arrest, 121 patients (10.1%) in the ECPR group were alive with favorable neurological outcomes, compared to 150 patients (0.8%) in the CCPR group. In a multivariate logistic regression analysis, ECPR was associated with a statistically significant increase in the odds of favorable neurological outcomes compared to CCPR (adjusted odds ratio: 2.01 [1.36-2.96], p< 0.001). Analysis using restricted cubic splines revealed a longer effective treatment window for ECPR, with a critical time point of 66 minutes, compared to 25 minutes for CCPR.

Conclusions: Our study suggests that ECPR is associated with improved neurological outcomes and extends the effective treatment window compared to CCPR.