Headline: Faster ECPR Delivery Linked to Improved Survival and Neurological Outcomes in OHCA Patients
Lead: A extensive analysis of a nationwide Japanese database reveals a important correlation between reduced door-to-extracorporeal cardiopulmonary resuscitation (ECPR) times and enhanced survival rates, and also better neurological recovery, for patients experiencing out-of-hospital cardiac arrest (OHCA). The findings underscore the critical importance of rapid ECPR implementation as a key performance indicator for quality care.
Context: For individuals suffering cardiac arrest outside of a hospital setting, the speed at which advanced life support, specifically ECPR, is initiated can be a decisive factor in their chances of survival and the quality of their neurological function post-resuscitation. This study delves into the impact of hospital-level efficiency in delivering ECPR on patient outcomes.
Study Details:
- Data Source: A nationwide Japanese database of OHCA patients.
- Setting: The research encompassed data from fifty-three hospitals located throughout Japan.
- Participants: The study included adult patients who received ECPR between the years 2014 and 2021. Hospitals were classified into two groups: “rapid” and “delayed,” based on their median door-to-ECPR times.
- Interventions: No specific interventions were applied as part of the study design.
- Key Findings: The primary measure of success was 30-day survival.Secondary outcomes assessed included survival at 30 and 90 days, with a focus on those achieving favorable neurological outcomes. Propensity score weighting was employed to account for potential confounding factors. The analysis included a total of 2136 patients from the 53 participating hospitals.hospitals demonstrating shorter median door-to-ECPR times exhibited higher 30-day survival rates, with an odds ratio (OR) of 1.36 (95% confidence interval [CI], 1.21-1.53). Furthermore, patients treated at hospitals with faster ECPR initiation experienced superior neurological outcomes at both the 30-day (OR, 1.47; 95% CI, 1.24-1.73) and 90-day (OR, 1.47; 95% CI,1.25-1.73) follow-up points.
- Conclusion: the study concludes that the median door-to-ECPR time at the hospital level is a vital determinant of both survival and neurological recovery for OHCA patients requiring ECPR. Consequently, achieving shorter door-to-ECPR times should be recognized as a critical quality benchmark for ECPR protocols.
Keywords: door-to-extracorporeal cardiopulmonary resuscitation time; extracorporeal cardiopulmonary resuscitation; neurological outcomes; out-of-hospital cardiac arrest; quality indicator; survival.