Nishimura Takeshi, Nakatani Yukihide, Kaneda Haruki, Tsunemitsu Takefumi, Taira Takuya, Suga Masafumi, Ijuin Shinichi, Inoue Akihiko, Ishihara Satoshi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe City, Hyogo, Japan.
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe City, Hyogo, Japan.
Am J Emerg Med. 2025 Dec;98:227-233. doi: 10.1016/j.ajem.2025.08.056. Epub 2025 Aug 25.
The influence of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) patients who received extracorporeal pulmonary resuscitation (ECPR) has not yet been fully elucidated. We examined whether there were differences in ECPR frequency and outcomes for OHCA patients who received ECPR during the pandemic.
Using the nationwide JAAM-OHCA registry, we evaluated OHCA patients who received ECPR from 2019 to 2022. Since the first state of emergency was declared in April 2020, we compared outcomes for OHCA patients before the pandemic (January 1, 2019 to March 31, 2020) and those during the pandemic (from April 1, 2020 to December 31, 2022). We performed logistic regression analysis adjusted for age, sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, initial/on hospital arrival shockable rhythm, and time from call to extracorporeal membrane oxygenation initiation, as well as interrupted time series analysis (ITSA). The primary outcome was the proportion of 30-day favorable neurological outcomes, defined as Cerebral Performance Category scores of 1-2 between two groups.
After excluding patients, 1903 ECPR cases (681 in the pre-pandemic group and 1222 in the pandemic group) were included in the study. ECPR frequency decreased during the pandemic (4.4 % [681/15,344], 45.4 cases per month in the pre-pandemic group, and 3.8 % [1222/32,020], 37.1 cases per month in the pandemic group, odds ratio (OR) 0.86, 95 % confidence interval (CI) 0.78-0.94, p < 0.01). Multivariable logistic regression analysis revealed the COVID-19 pandemic was not associated with 30-day favorable neurological outcomes (12.5 % [85/681] in the pre-pandemic group and 12.6 % [154/1221] in the pandemic group, OR 0.92, 95 % CI 0.67-1.30, p = 0.64). ITSA revealed the frequency of ECPR decreased significantly (-17.2 per month, 95 % CI -26.0--8.5, p < 0.01), while the proportion of 30-day favorable neurological outcomes did not differ (relative risk 1.16, 95 % CI 0.70-1.96, p = 0.56) during the pandemic period.
Although the frequency of ECPR for OHCA patients decreased, prognoses, including favorable neurological outcomes, did not differ during the COVID-19 pandemic.
2019冠状病毒病（COVID-19）大流行对接受体外膜肺氧合心肺复苏（ECPR）的院外心脏骤停（OHCA）患者的影响尚未完全阐明。我们研究了大流行期间接受ECPR的OHCA患者在ECPR频率和预后方面是否存在差异。
利用全国性的日本急性医学协会院外心脏骤停（JAAM-OHCA）登记系统，我们评估了2019年至2022年期间接受ECPR的OHCA患者。自2020年4月宣布首次紧急状态以来，我们比较了大流行前（2019年1月1日至2020年3月31日）和大流行期间（2020年4月1日至2022年12月31日）OHCA患者的预后。我们进行了逻辑回归分析，对年龄、性别、目击心脏骤停、旁观者心肺复苏、初始/入院时可电击心律以及从呼叫到开始体外膜肺氧合的时间进行了校正，同时进行了中断时间序列分析（ITSA）。主要结局是30天良好神经功能预后的比例，定义为两组之间脑功能分类评分为1-2分。
排除患者后，1903例ECPR病例（大流行前组681例，大流行组1222例）纳入研究。大流行期间ECPR频率下降（4.4%[681/15344]，大流行前组每月45.4例，3.8%[1222/32020]，大流行组每月37.1例，优势比（OR）0.86，95%置信区间（CI）0.78-0.94，p<0.01）。多变量逻辑回归分析显示，COVID-19大流行与30天良好神经功能预后无关（大流行前组为12.5%[85/681]，大流行组为12.6%[154/1221]，OR 0.92，95%CI 0.67-1.30，p=0.64）。ITSA显示，大流行期间ECPR频率显著下降（每月-17.2例，95%CI -26.0--8.5，p<0.01），而30天良好神经功能预后的比例没有差异（相对风险1.16，95%CI 0.70-1.96，p=0.56）。
虽然OHCA患者的ECPR频率下降，但在COVID-19大流行期间，包括良好神经功能预后在内的预后并无差异。
