Impact of center volume on in-hospital mortality in adult patients with out‑of‑hospital cardiac arrest resuscitated using extracorporeal cardiopulmonary resuscitation: a secondary analysis of the SAVE-J II study

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2024年4月9日

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Kayo Misumi,
Yoshihiro Hagiwara,
Takuya Kimura,
Toru Hifumi,
Akihiko Inoue,
Tetsuya Sakamoto,
Yasuhiro Kuroda,
Takayuki Ogura,
Hirotaka Sawano,
Yuko Egawa,
Shunichi Kato,
Kazuhiro Sugiyama,
Naofumi Bunya,
Takehiko Kasai,
Shinichi Ijuin,
Shinichi Nakayama,
Jun Kanda,
Seiya Kanou,
Toru Takiguchi,
Shoji Yokobori,
Hiroaki Takada,
Kazushige Inoue,
Ichiro Takeuchi,
Hiroshi Honzawa,
Makoto Kobayashi,
Tomohiro Hamagami,
Wataru Takayama,
Yasuhiro Otomo,
Kunihiko Maekawa,
Takafumi Shimizu,
Satoshi Nara,
Michitaka Nasu,
Kuniko Takahashi,
Reo Fukuda,
Shinichiro Shiraishi,
Ryosuke Zushi,
Norio Otani,
Migaku Kikuchi,
Kazuhiro Watanabe,
Takuo Nakagami,
Tomohisa Shoko,
Nobuya Kitamura,
Takayuki Otani,
Yoshinori Matsuoka,
Masaaki Sakuraya,
Hideki Arimoto,
Koichiro Homma,
Hiromichi Naito,
Shunichiro Nakao,
Tomoya Okazaki,
Yoshio Tahara,
Hiroshi Okamoto,
Jun Kunikata,
Hideto Yokoi

摘要

Recently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11–20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P = 0.003) and low-volume centers (adjusted odds ratio 0.983; P = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure.

Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).