PMID- 37544497
OWN - NLM
STAT- MEDLINE
DCOM- 20230927
LR  - 20231003
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 191
DP  - 2023 Oct
TI  - Neurological outcomes and reperfusion strategies in out-of-hospital cardiac 
      arrest patients due to pulmonary embolism who underwent venoarterial 
      extracorporeal membrane oxygenation: A post-hoc analysis of a multicenter 
      retrospective cohort study.
PG  - 109926
LID - S0300-9572(23)00239-3 [pii]
LID - 10.1016/j.resuscitation.2023.109926 [doi]
AB  - INTRODUCTION: This study aimed to evaluate the effect of different reperfusion 
      strategies on neurological outcomes in patients with pulmonary embolism who 
      received venoarterial extracorporeal membrane oxygenation (VA-ECMO) for 
      out-of-hospital cardiac arrest (OHCA). METHODS: This was a post-hoc analysis of a 
      multicenter retrospective cohort study conducted in 36 institutions in Japan over 
      six years. We included patients who underwent VA-ECMO and were diagnosed with 
      pulmonary embolism caused by OHCA. Neurological outcomes were evaluated on the 
      basis of the cerebral performance category at hospital discharge. We also 
      assessed the association between reperfusion strategies and successful separation 
      from ECMO. RESULTS: Among the 78 included patients, approximately half were 
      successfully weaned from ECMO. Hospital mortality and favorable neurological 
      outcomes at hospital discharge were 60.3% and 17.9%, respectively. Thirty-one 
      patients (39.7%) underwent reperfusion strategies after ECMO, including 13 who 
      received systemic thrombolytic therapy and 18 who underwent mechanical 
      reperfusion strategy. After adjusting for prespecified covariates using the 
      competing risk model, reperfusion strategies increased ECMO separation rate 
      (systemic thrombolytic therapy: subdistribution hazard ratio [sHR] 2.24, 95% 
      confidence interval [CI] 1.21-4.17, P = 0.011; mechanical reperfusion strategy: 
      sHR 1.70, 95% CI 0.86-3.41, P = 0.129) compared with anticoagulation therapy 
      alone, whereas higher cardiac Sequential Organ Failure Assessment score decreased 
      ECMO separation rate (sHR 0.81, 95% CI 0.67-0.97, P = 0.020). CONCLUSIONS: 
      Favorable neurological outcomes were observed in less than 20% of patients with 
      OHCA due to pulmonary embolism undergoing ECMO. Reperfusion strategies may be 
      associated with shorter ECMO durations in these patients. CLINICAL TRIAL 
      REGISTRATION: 
      https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 
      (unique identifier: UMIN000036490).
CI  - Copyright (c) 2023. Published by Elsevier B.V.
FAU - Sakuraya, Masaaki
AU  - Sakuraya M
AD  - JA Hiroshima General Hospital, Department of Emergency and Intensive Care 
      Medicine, Jigozen 1-3-3, Hatsukaichi, Hiroshima 738-8503, Japan; Shiga 
      University, Graduate School of Data Science, 1-1-1 Banba, Hikone, Shiga 522-8522, 
      Japan. Electronic address: masaaki.sakuraya@gmail.com.
FAU - Hifumi, Toru
AU  - Hifumi T
AD  - St. Luke's International Hospital, Department of Emergency and Critical Care 
      Medicine, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan. Electronic address: 
      hifumitoru@gmail.com.
FAU - Inoue, Akihiko
AU  - Inoue A
AD  - Hyogo Emergency Medical Center, Department of Emergency and Critical Care 
      Medicine, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan. 
      Electronic address: i.akihiko1985@gmail.com.
FAU - Sakamoto, Tetsuya
AU  - Sakamoto T
AD  - Teikyo University School of Medicine, Department of Emergency Medicine, 2-11-1 
      Kaga, Itabashi-ku, Tokyo 173-8605, Japan. Electronic address: 
      sakamoto.tetsuya@nifty.ne.jp.
FAU - Kuroda, Yasuhiro
AU  - Kuroda Y
AD  - Kagawa University Hospital, Department of Emergency, Disaster and Critical Care 
      Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. Electronic 
      address: kuroda.yasuhiro@kagawa-u.ac.jp.
CN  - SAVE-J Ⅱ Study Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20230805
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
CIN - Resuscitation. 2023 Oct;191:109953. PMID: 37657744
MH  - Humans
MH  - *Out-of-Hospital Cardiac Arrest/etiology/therapy
MH  - *Extracorporeal Membrane Oxygenation
MH  - Retrospective Studies
MH  - *Pulmonary Embolism/complications/therapy
MH  - Reperfusion
OTO - NOTNLM
OT  - Cerebral performance category
OT  - Extracorporeal membrane oxygenation
OT  - Neurological outcome
OT  - Out-of-hospital cardiac arrest
OT  - Pulmonary embolism
OT  - Reperfusion strategy
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2023/08/07 00:42
MHDA- 2023/09/27 06:43
CRDT- 2023/08/06 19:16
PHST- 2023/05/06 00:00 [received]
PHST- 2023/07/28 00:00 [revised]
PHST- 2023/07/31 00:00 [accepted]
PHST- 2023/09/27 06:43 [medline]
PHST- 2023/08/07 00:42 [pubmed]
PHST- 2023/08/06 19:16 [entrez]
AID - S0300-9572(23)00239-3 [pii]
AID - 10.1016/j.resuscitation.2023.109926 [doi]
PST - ppublish
SO  - Resuscitation. 2023 Oct;191:109926. doi: 10.1016/j.resuscitation.2023.109926. 
      Epub 2023 Aug 5.