PMID- 31513865
OWN - NLM
STAT- MEDLINE
DCOM- 20201001
LR  - 20201001
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 144
DP  - 2019 Nov
TI  - Extracorporeal membrane oxygenation improves outcomes of accidental hypothermia 
      without vital signs: A nationwide observational study.
PG  - 27-32
LID - S0300-9572(19)30606-9 [pii]
LID - 10.1016/j.resuscitation.2019.08.041 [doi]
AB  - AIM: Patients with accidental hypothermia without vital signs increasingly 
      receive venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, 
      there is limited knowledge regarding the efficacy of this advanced rewarming 
      method. We aimed to determine whether VA-ECMO improved outcomes in patients with 
      accidental hypothermia without vital signs, using a large nationwide inpatient 
      database in Japan. METHODS: Using the Japanese Diagnosis Procedure Combination 
      inpatient database from July 2010 to March 2017, we identified patients diagnosed 
      with accidental hypothermia who received closed-chest cardiac massage in-hospital 
      on the day of admission. Patients who received VA-ECMO on the day of admission 
      were allocated to the VA-ECMO group, and those who received cardiopulmonary 
      resuscitation (CPR) only were allocated to the conventional CPR group. The 
      primary outcome was in-hospital mortality, and the secondary outcome was a Japan 
      Coma Scale status of "alert consciousness" at discharge. Propensity 
      score-matching analyses were performed to compare the outcomes. RESULTS: We 
      identified 1661 eligible patients during the 81-month study period, and 318 (19%) 
      received VA-ECMO on the day of admission. Crude in-hospital mortality was 65% in 
      the VA-ECMO group and 84% in the conventional CPR group. Propensity 
      score-matching analyses demonstrated significantly lower in-hospital mortality 
      (risk difference: -13%; 95% confidence interval: -21% to -5.1%) and a higher 
      proportion of "alert consciousness" at discharge (risk difference: 8.3%; 95% 
      confidence interval: 1.9%-15%) in the VA-ECMO group compared with the 
      conventional CPR group. CONCLUSION: VA-ECMO was associated with higher survival 
      and favourable neurological outcomes compared with conventional CPR alone in 
      patients with accidental hypothermia without vital signs.
CI  - Copyright (c) 2019 Elsevier B.V. All rights reserved.
FAU - Ohbe, Hiroyuki
AU  - Ohbe H
AD  - Department of Clinical Epidemiology and Health Economics, School of Public 
      Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. 
      Electronic address: hohbey@gmail.com.
FAU - Isogai, Shunsuke
AU  - Isogai S
AD  - Department of Clinical Epidemiology and Health Economics, School of Public 
      Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
FAU - Jo, Taisuke
AU  - Jo T
AD  - Department of Health Services Research, The University of Tokyo, 7-3-1 Hongo, 
      Bunkyo-ku, Tokyo 113-0033, Japan.
FAU - Matsui, Hiroki
AU  - Matsui H
AD  - Department of Clinical Epidemiology and Health Economics, School of Public 
      Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
FAU - Fushimi, Kiyohide
AU  - Fushimi K
AD  - Department of Health Policy and Informatics, Tokyo Medical and Dental University 
      Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
FAU - Yasunaga, Hideo
AU  - Yasunaga H
AD  - Department of Clinical Epidemiology and Health Economics, School of Public 
      Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190909
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiopulmonary Resuscitation
MH  - Databases, Factual
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Hospital Mortality
MH  - Hospitalization
MH  - Humans
MH  - Hypothermia/mortality/*therapy
MH  - Japan
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - *Rewarming
MH  - Treatment Outcome
MH  - Vital Signs
OTO - NOTNLM
OT  - Accidental hypothermia
OT  - Cardiac arrest
OT  - Cardiopulmonary resuscitation
EDAT- 2019/09/13 06:00
MHDA- 2020/10/02 06:00
CRDT- 2019/09/13 06:00
PHST- 2019/05/17 00:00 [received]
PHST- 2019/08/17 00:00 [revised]
PHST- 2019/08/25 00:00 [accepted]
PHST- 2019/09/13 06:00 [pubmed]
PHST- 2020/10/02 06:00 [medline]
PHST- 2019/09/13 06:00 [entrez]
AID - S0300-9572(19)30606-9 [pii]
AID - 10.1016/j.resuscitation.2019.08.041 [doi]
PST - ppublish
SO  - Resuscitation. 2019 Nov;144:27-32. doi: 10.1016/j.resuscitation.2019.08.041. Epub 
      2019 Sep 9.