Abstract：
OBJECTIVE: Selecting the appropriate candidates for extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is challenging. Previously, the Extracorporeal Life Support Organization (ELSO) guidelines suggested the example of inclusion criteria. However, it is unclear whether patients who meet the inclusion criteria of the ELSO guidelines have more favorable outcomes. We aimed to evaluate the relationship between the outcomes and select inclusion criteria of the ELSO guidelines.
METHODS: We conducted a post-hoc analysis of a multicenter prospective study conducted between 2019 and 2021. Adult patients with OHCA treated with ECPR were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. An ELSO criteria score was assigned based on four criteria: (i) age < 70 years; (ii) witness; (iii) bystander CPR; and (iv) low-flow time (<60 min). Subgroup analysis based on initial cardiac rhythm was performed.
RESULTS: Among 9,909 patients, 227 with OHCA were included. The proportion of favorable neurological outcomes according to the number of ELSO criteria met were: 0.0% (0/3), 0 points; 0.0% (0/23), 1 point; 3.0% (2/67), 2 points; 7.3% (6/82), 3 points; and 16.3% (7/43), 4 points. A similar tendency was observed in patients with an initial shockable rhythm. However, no such relationship was observed in those with an initial non-shockable rhythm.
CONCLUSIONS: Patients who adhered more closely to specific inclusion criteria of the ELSO guidelines demonstrated a tendency towards a higher rate of favorable neurological outcomes. However, the relationship was heterogeneous according to initial rhythm.
METHODS: We conducted a post-hoc analysis of a multicenter prospective study conducted between 2019 and 2021. Adult patients with OHCA treated with ECPR were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. An ELSO criteria score was assigned based on four criteria: (i) age < 70 years; (ii) witness; (iii) bystander CPR; and (iv) low-flow time (<60 min). Subgroup analysis based on initial cardiac rhythm was performed.
RESULTS: Among 9,909 patients, 227 with OHCA were included. The proportion of favorable neurological outcomes according to the number of ELSO criteria met were: 0.0% (0/3), 0 points; 0.0% (0/23), 1 point; 3.0% (2/67), 2 points; 7.3% (6/82), 3 points; and 16.3% (7/43), 4 points. A similar tendency was observed in patients with an initial shockable rhythm. However, no such relationship was observed in those with an initial non-shockable rhythm.
CONCLUSIONS: Patients who adhered more closely to specific inclusion criteria of the ELSO guidelines demonstrated a tendency towards a higher rate of favorable neurological outcomes. However, the relationship was heterogeneous according to initial rhythm.
摘要：
目的：为院外心脏骤停（OHCA）患者选择合适的体外心肺复苏（ECPR）患者具有挑战性。以前,体外生命支持组织（ELSO）指南提出了纳入标准的示例。然而,目前尚不清楚符合ELSO指南纳入标准的患者是否具有更有利的结局.我们旨在评估结果之间的关系，并选择ELSO指南的纳入标准。
方法：我们对2019年至2021年进行的多中心前瞻性研究进行了事后分析。包括接受ECPR治疗的成年OHCA患者。主要结果是在30天时良好的神经系统结局（脑功能类别为1或2）。根据四个标准分配ELSO标准评分：（i）年龄<70岁；（ii）证人；（iii）旁观者CPR；和（iv）低流量时间（<60分钟）。根据初始心律进行亚组分析。
结果：在9,909名患者中，227与OHCA包括在内。根据符合ELSO标准的数量，神经系统预后良好的比例为：0.0％（0/3），0分；0.0%（0/23），1分；3.0%(2/67)，2分；7.3%(6/82)，3分；和16.3%（7/43），4分。在具有初始可电击节律的患者中观察到类似的趋势。然而,在具有初始不可电击节律的患者中未观察到这种关系.
结论：更密切地坚持ELSO指南的特定纳入标准的患者表现出更高的神经系统转归率倾向。然而,根据初始节奏，这种关系是异质的。
方法：我们对2019年至2021年进行的多中心前瞻性研究进行了事后分析。包括接受ECPR治疗的成年OHCA患者。主要结果是在30天时良好的神经系统结局（脑功能类别为1或2）。根据四个标准分配ELSO标准评分：（i）年龄<70岁；（ii）证人；（iii）旁观者CPR；和（iv）低流量时间（<60分钟）。根据初始心律进行亚组分析。
结果：在9,909名患者中，227与OHCA包括在内。根据符合ELSO标准的数量，神经系统预后良好的比例为：0.0％（0/3），0分；0.0%（0/23），1分；3.0%(2/67)，2分；7.3%(6/82)，3分；和16.3%（7/43），4分。在具有初始可电击节律的患者中观察到类似的趋势。然而,在具有初始不可电击节律的患者中未观察到这种关系.
结论：更密切地坚持ELSO指南的特定纳入标准的患者表现出更高的神经系统转归率倾向。然而,根据初始节奏，这种关系是异质的。
