Extracorporeal CPR improves survival rate in refractory cardiac arrest: NEJM

A new study published in the New England Journal of Medicine suggests that extracorporeal cardiopulmonary resuscitation (CPR) and traditional CPR both improved survival rates and neurologic outcomes in patients with refractory out-of-hospital cardiac arrest. 

In a patient without spontaneous circulation, extracorporeal cardiopulmonary resuscitation provides perfusion and oxygenation. The evidence is conflicting about extracorporeal CPR's impact on survival with a good neurologic outcome in cases of refractory out-of-hospital cardiac arrest. To compare the effectiveness of extracorporeal cardiopulmonary resuscitation versus the traditional approach, Martje Suverein and colleagues conducted this study.

Researchers randomly allocated patients who experienced an out-of-hospital cardiac arrest to either extracorporeal CPR or traditional CPR in this multicenter, randomized experiment that was carried out in the Netherlands (standard advanced cardiac life support). Patients had to be between the ages of 18 and 70, have undergone bystander CPR, have an initial ventricular arrhythmia, and not experience a recovery of spontaneous circulation in 15 minutes after the start of CPR. The main result was survival with a good neurologic outcome, which was determined by a Cerebral Performance Category score of 1 or 2 at 30 days (range: 1 to 5; higher scores indicate more severe impairment). On the basis of intention-to-treat, analyses were conducted.

The key findings of this study were:

Out of 160 patients who were randomly allocated, 70 received extracorporeal CPR and 64 conventional CPR; 26 patients were eliminated because they did not match the inclusion criteria at the time of hospital admission. 

Compared to 10 patients (16%) in the conventional CPR group, 14 patients (20%) in the extracorporeal CPR group were still alive and had a positive neurologic outcome at 30 days (odds ratio, 1.4; 95% confidence range, 0.5 to 3.5; P=0.52). 

In both groups, the average number of major adverse events per patient was comparable.

Reference:

Suverein, M. M., Delnoij, T. S. R., Lorusso, R., Brandon Bravo Bruinsma, G. J., Otterspoor, L., Elzo Kraemer, C. V., Vlaar, A. P. J., van der Heijden, J. J., Scholten, E., Heijnen, B. G., Dos Reis Miranda, D., … van de Poll, M. C. G. (2023). Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. In New England Journal of Medicine (Vol. 388, Issue 4, pp. 299–309). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa220451