Abstract：
BACKGROUND: A better understanding of the relative contributions of various factors to patient outcomes is essential for optimal patient selection for extracorporeal CPR (ECPR) therapy for patients with out-of-hospital cardiac arrest (OHCA). However, evidence on the prognostic comparison based on the etiologies of cardiac arrest is limited.
OBJECTIVE: What is the etiology-based prognosis of patients undergoing ECPR for OHCA?
METHODS: This retrospective multicenter registry study involved 36 institutions in Japan and included all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. The primary etiology for OHCA was determined retrospectively from all hospital-based data at each institution. We performed a multivariable logistic regression model to determine the association between etiology of cardiac arrest and two outcomes: favorable neurologic outcome and survival at hospital discharge.
RESULTS: We identified 1,781 eligible patients, of whom 1,405 (78.9%) had cardiac arrest because of cardiac causes. Multivariable logistic regression analysis for favorable neurologic outcome showed that accidental hypothermia (adjusted OR, 5.12; 95% CI, 2.98-8.80; P < .001) was associated with a significantly higher rate of favorable neurologic outcome than cardiac causes. Multivariable logistic regression analysis for survival showed that accidental hypothermia (adjusted OR, 5.19; 95% CI, 3.15-8.56; P < .001) had significantly higher rates of survival than cardiac causes. Acute aortic dissection/aneurysm (adjusted OR, 0.07; 95% CI, 0.02-0.28; P < .001) and primary cerebral disorders (adjusted OR, 0.12; 95% CI, 0.03-0.50; P = .004) had significantly lower rates of survival than cardiac causes.
CONCLUSIONS: In this retrospective multicenter cohort study, although most patients with OHCA underwent ECPR for cardiac causes, accidental hypothermia was associated with favorable neurologic outcome and survival; in contrast, acute aortic dissection/aneurysm and primary cerebral disorders were associated with nonsurvival compared with cardiac causes.
OBJECTIVE: What is the etiology-based prognosis of patients undergoing ECPR for OHCA?
METHODS: This retrospective multicenter registry study involved 36 institutions in Japan and included all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. The primary etiology for OHCA was determined retrospectively from all hospital-based data at each institution. We performed a multivariable logistic regression model to determine the association between etiology of cardiac arrest and two outcomes: favorable neurologic outcome and survival at hospital discharge.
RESULTS: We identified 1,781 eligible patients, of whom 1,405 (78.9%) had cardiac arrest because of cardiac causes. Multivariable logistic regression analysis for favorable neurologic outcome showed that accidental hypothermia (adjusted OR, 5.12; 95% CI, 2.98-8.80; P < .001) was associated with a significantly higher rate of favorable neurologic outcome than cardiac causes. Multivariable logistic regression analysis for survival showed that accidental hypothermia (adjusted OR, 5.19; 95% CI, 3.15-8.56; P < .001) had significantly higher rates of survival than cardiac causes. Acute aortic dissection/aneurysm (adjusted OR, 0.07; 95% CI, 0.02-0.28; P < .001) and primary cerebral disorders (adjusted OR, 0.12; 95% CI, 0.03-0.50; P = .004) had significantly lower rates of survival than cardiac causes.
CONCLUSIONS: In this retrospective multicenter cohort study, although most patients with OHCA underwent ECPR for cardiac causes, accidental hypothermia was associated with favorable neurologic outcome and survival; in contrast, acute aortic dissection/aneurysm and primary cerebral disorders were associated with nonsurvival compared with cardiac causes.
摘要：
背景：对于院外心脏骤停（OHCA）患者，更好地了解各种因素对患者预后的相对贡献对于选择最佳的体外心肺复苏（ECPR）治疗患者至关重要。然而,基于心脏骤停病因的预后比较证据有限.
目的：OHCA接受ECPR的患者基于病因的预后如何？
方法：这项回顾性多中心注册研究涉及日本的36个机构，包括2013年1月至2018年12月期间接受ECPR的所有OHCA成年患者。OHCA的主要病因是根据每个机构的所有基于医院的数据进行回顾性确定的。我们进行了多变量逻辑回归模型，以确定心脏骤停的病因与两种结局之间的关联：良好的神经系统结局和出院时的生存率。
结果：我们确定了1,781名合格患者，其中1,405人(78.9%)因心脏原因心脏骤停。多变量logistic回归分析显示，意外低温（校正OR=5.12；95％CI=2.98-8.80，P<0.001）与心脏原因的良好神经系统转归率明显高于心脏原因。生存的多因素logistic回归分析显示，意外低温（校正OR=5.19；95％CI=3.15-8.56，P<0.001）的生存率明显高于心脏原因。急性主动脉夹层/动脉瘤（校正OR=0.07，95％CI=0.02-0.28，P<0.001）和原发性脑疾病（校正OR=0.12，95％CI=0.03-0.50，P=0.004）的生存率明显低于心脏原因。
结论：在这项回顾性多中心队列研究中，尽管大多数OHCA患者因心脏原因接受了ECPR，意外的低体温与良好的神经系统预后和生存有关；相反，与心脏原因相比,急性主动脉夹层/动脉瘤和原发性脑疾病与非生存相关.
目的：OHCA接受ECPR的患者基于病因的预后如何？
方法：这项回顾性多中心注册研究涉及日本的36个机构，包括2013年1月至2018年12月期间接受ECPR的所有OHCA成年患者。OHCA的主要病因是根据每个机构的所有基于医院的数据进行回顾性确定的。我们进行了多变量逻辑回归模型，以确定心脏骤停的病因与两种结局之间的关联：良好的神经系统结局和出院时的生存率。
结果：我们确定了1,781名合格患者，其中1,405人(78.9%)因心脏原因心脏骤停。多变量logistic回归分析显示，意外低温（校正OR=5.12；95％CI=2.98-8.80，P<0.001）与心脏原因的良好神经系统转归率明显高于心脏原因。生存的多因素logistic回归分析显示，意外低温（校正OR=5.19；95％CI=3.15-8.56，P<0.001）的生存率明显高于心脏原因。急性主动脉夹层/动脉瘤（校正OR=0.07，95％CI=0.02-0.28，P<0.001）和原发性脑疾病（校正OR=0.12，95％CI=0.03-0.50，P=0.004）的生存率明显低于心脏原因。
结论：在这项回顾性多中心队列研究中，尽管大多数OHCA患者因心脏原因接受了ECPR，意外的低体温与良好的神经系统预后和生存有关；相反，与心脏原因相比,急性主动脉夹层/动脉瘤和原发性脑疾病与非生存相关.
