Low-flow time and outcomes in hypothermic cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: a secondary analysis of a multi-center retrospective cohort study

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2024年6月11日

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Kosuke Shoji,
Hiroyuki Ohbe,
Tasuku Matsuyama,
Akihiko Inoue,
Toru Hifumi,
Tetsuya Sakamoto,
Yasuhiro Kuroda,
Shigeki Kushimoto,
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,
Yoshihiro Hagiwara,
Reo Fukuda,
Takayuki Ogura,
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

Background

In out-of-hospital cardiac arrest (OHCA) patients with extracorporeal cardiopulmonary resuscitation (ECPR), the association between low-flow time and outcomes in accidental hypothermia (AH) patients compared to those of patients without AH has not been fully investigated.

Methods

This was a secondary analysis of the retrospective multicenter registry in Japan. We enrolled patients aged ≥ 18 years who had been admitted to the emergency department for OHCA and had undergone ECPR between January, 2013 and December, 2018. AH was defined as an arrival body temperature below 32 °C. The primary outcome was survival to discharge. Cubic spline analyses were performed to assess the non-linear associations between low-flow time and outcomes stratified by the presence of AH. We also analyzed the interaction between low-flow time and the presence of AH.

Results

Of 1252 eligible patients, 105 (8.4%) and 1147 (91.6%) were in the AH and non-AH groups, respectively. Median low-flow time was 60 (47–79) min in the AH group and 51 (42–62) min in the non-AH group. The survival discharge rates in the AH and non-AH groups were 44.8% and 25.4%, respectively. The cubic spline analyses showed that survival discharge rate remained constant regardless of low-flow time in the AH group. Conversely, a decreasing trend was identified in the survival discharge rate with longer low-flow time in the non-AH group. The interaction analysis revealed a significant interaction between low-flow time and AH in survival discharge rate (p for interaction = 0.048).

Conclusions

OHCA patients with arrival body temperature < 32 °C who had received ECPR had relatively good survival outcomes regardless of low-flow time, in contrast to those of patients without AH.