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Extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) is increasing. There is little evidence identifying the association between hospital ECLS case volumes and outcomes in different populations receiving ECLS or conventional cardiopulmonary resuscitation (CPR). The goal of this investigation was to identify the association between ECLS case volumes and clinical outcomes of OHCA patients. This cross-sectional observational study used the National OHCA Registry for adult OHCA cases in Seoul, Korea between January 2015 and December 2019. If the ECLS volume during the study period was >20, the institution was defined as a high-volume ECLS center. Others were defined as low-volume ECLS centers. Outcomes were good neurologic recovery (cerebral performance category 1 or 2) and survival to discharge. We performed multivariate logistic regression and interaction analyses to assess the association between case volume and clinical outcome. Of the 17,248 OHCA cases, 3,731 were transported to high-volume centers. Among the patients who underwent ECLS, those at high-volume centers had a higher neurologic recovery rate than those at low-volume centers (17.0% vs. 12.0%), and the adjusted OR for good neurologic recovery was 2.22 (95% confidence interval (CI): 1.15–4.28) in high-volume centers compared to low-volume centers. For patients who received conventional CPR, high-volume centers also showed higher survival-to-discharge rates (adjusted OR of 1.16, 95%CI: 1.01–1.34). High-volume ECLS centers showed better neurological recovery in patients who underwent ECLS. High-volume centers also had better survival-to-discharge rates than low-volume centers for patients not receiving ECLS. [ABSTRACT FROM AUTHOR]

Background: The benefit of extracorporeal life support (ECLS) in highly selective patients with out-of-hospital cardiac arrest (OHCA) is supported by previous studies; however, it is unclear whether the effects of ECLS are observed at a population level. This study aimed to determine whether ECLS is associated with improved survival outcomes compared to conventional CPR (cardiopulmonary resuscitation) at a national level.Methods: We used a Korean national OHCA cohort database from 2009 to 2013. The inclusion criteria were OHCA adults with presumed cardiac aetiology and resuscitation by emergency medical services (EMS). Patients were excluded if their information on prehospital time intervals or clinical outcomes at hospital discharge was incomplete or not captured. The primary outcome was neurologically favourable survival to discharge. We compared the primary outcomes between the ECLS and non-ECLS groups using a multivariable logistic regression and a propensity score matching analysis.Results: Of the 119,077 patients with OHCA, 36,547 were included in the analysis. There were 320 patients who received ECLS. There was no significant difference in neurologically favourable survival to discharge between the ECLS group and the non-ECLS group after adjusting for covariates (adjusted OR, 0.65; 95% CI, 0.41-1.04). In the propensity score-matched cohort, there was also no significant difference between the two groups (adjusted OR, 0.94; 95% CI, 0.41-2.14).Conclusions: In this propensity score-matched cohort using a nationwide OHCA database, OHCA victims who received ECLS did not show better survival outcomes than those who did not receive ECLS. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective, single-center observational study on the survival of patients with inhospital cardiac arrest who received extracorporeal cardiopulmonary resuscitation (E-CPR) and those who underwent the conventional CPR. A total of 406 adult patients were involved in the study at Samsung Medical Center in Seoul, South Korea. It found that E-CPR had more survival benefits than conventional CPR.

Introduction: Mortality is very high in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) or cardiac arrest despite intensive use of percutaneous coronary intervention (PCI). Although current guidelines still recommend rapid revascularization in these high-risk patients, several studies showed the benefit of extracorporeal membrane oxygenation (ECMO)-assisted PCI. Hypothesis: ECMO support before revascularization might be beneficial in patients with AMI complicated by profound CS after resuscitated cardiac arrest. Methods: Among 116,374 patients experiencing out-of-hospital cardiac arrest in all emergency medical service of South Korea between 2013 and 2016, a total of 147 resuscitated patients with AMI complicated by profound CS who were treated with both PCI and ECMO were enrolled. Exclusion criteria were as follows: non-cardiac arrest, duration of cardiopulmonary resuscitation < 20 minutes, patients without restoration of spontaneous circulation, patients treated with thrombolysis, patients who did not receive PCI, patients did not receive ECMO treatment, and cases of failed PCI. Enrolled patients were divided into two groups according to timing of ECMO; pre-PCI ECMO group (n = 82) vs. post-PCI ECMO group (n = 65). We compared 30-day mortality between two groups. Results: Age and proportion of male gender were similar between 2 groups. The rate of bystander CPR (29.3% vs. 29.2%, p = 0.996) and shockable rhythm at emergency room (26.8% vs. 26.2%, p = 0.927) were also comparable in 2 groups. Although total duration of CPR was similar between 2 groups (57.4±27.6 vs. 52.0±28.8 minutes, p = 0.313), door to revascularization time was significantly longer in pre-PCI ECMO group than post-PCI ECMO group (123.7±57.6 vs. 105.5±39.1 minutes, p = 0.030). At 30-days, overall mortality was 80.3% (118 patients) in study population, and it was significantly lowered in pre-PCI ECMO group (72.0% vs. 90.8%, p = 0.004). In multivariate Cox-regression analysis, pre-PCI ECMO reduced 30-day mortality compared to post-PCI ECMO (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.47-0.98, p = 0.041). Bystander CPR , shockable rhythm at emergency room and successful therapeutic hypothermia were also associated with reduced 30-day mortality. Conclusions: ECMO treatment before PCI was associated with reduced 30-day mortality compared to ECMO after revascularization in patients with AMI complicated by profound CS after resuscitated cardiac arrest. [ABSTRACT FROM AUTHOR]