Hongo Takashi, Yumoto Tetsuya, Nojima Tsuyoshi, Obara Takafumi, Ueda Yoshiyuki, Yorifuji Takashi, Nakao Atsunori, Naito Hiromichi
Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, 2-5-1 Shikata, Kita, Okayama 700-8558, Japan.
Okayama University, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Department of Epidemiology, 2-5-1 Shikata, Kita, Okayama 700-8558, Japan.
Resusc Plus. 2025 Aug 11;25:101057. doi: 10.1016/j.resplu.2025.101057. eCollection 2025 Sep.
Few studies have examined mid-term neurological changes in out-of-hospital cardiac arrest (OHCA) patients after receiving extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to evaluate neurological improvements between 30 and 90 days in OHCA patients treated with ECPR or conventional cardiopulmonary resuscitation (CCPR) using a large nationwide cohort.
This retrospective multicenter study used data from a Japanese nationwide OHCA registry. Participants were categorized into ECPR and CCPR groups based on the initial resuscitation method. Neurological changes between 30 and 90 days were assessed using Cerebral Performance Category (CPC) scores. The primary outcome was neurological improvement, defined as an improvement in CPC score during this period.
A total of 4467 OHCA survivors at 30 days were included, 669 in the ECPR group and 3798 in the CCPR group. At 30 days, favorable neurological outcomes were observed in 318 ECPR patients (47.5 %) and 2103 CCPR patients (55.4 %). Neurological improvement between 30 and 90 days was more frequent in the ECPR group (83 [12.4 %] vs. 258 [6.7 %]). There was no significant difference in 90-day mortality between the two groups (82 [12.2 %] vs. 519 [13.6 %]). ECPR was independently associated with 30- to 90-day neurological improvement (adjusted odds ratio (OR) 2.01; 95 % confidence interval (CI), 1.38-2.93) but was not associated with 90-day mortality (adjusted OR 1.11; 95 % CI, 0.77-1.59).
ECPR was associated with a greater likelihood of neurological improvement between 30 and 90 days. By 90 days, mortality was nearly the same in both groups.
很少有研究探讨院外心脏骤停（OHCA）患者接受体外心肺复苏（ECPR）后的中期神经功能变化。本研究旨在利用一个大型全国性队列，评估接受ECPR或传统心肺复苏（CCPR）治疗的OHCA患者在30至90天之间神经功能的改善情况。
这项回顾性多中心研究使用了来自日本全国OHCA登记处的数据。根据初始复苏方法将参与者分为ECPR组和CCPR组。使用脑功能分类（CPC）评分评估30至90天之间的神经功能变化。主要结局是神经功能改善，定义为在此期间CPC评分的改善。
共纳入4467例30天存活的OHCA患者，其中ECPR组669例，CCPR组3798例。在30天时，318例ECPR患者（47.5%）和2103例CCPR患者（55.4%）观察到良好的神经功能结局。ECPR组在30至90天之间神经功能改善更为频繁（83例[12.4%]对258例[6.7%]）。两组90天死亡率无显著差异（82例[12.2%]对519例[13.6%]）。ECPR与30至90天神经功能改善独立相关（调整后的优势比[OR]为2.01；95%置信区间[CI]，1.38 - 2.93），但与90天死亡率无关（调整后的OR为1.11；95%CI，0.77 - 1.59）。
ECPR与30至90天之间神经功能改善的可能性更大相关。到90天时，两组死亡率几乎相同。
