TY - JOUR
T1 - Patient and institutional characteristics influence the decision to use extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest
AU - American Heart Association’s Get With the Guidelines—Resuscitation Investigators
AU - Tonna, Joseph E.
AU - Selzman, Craig H.
AU - Girotra, Saket
AU - Presson, Angela P.
AU - Thiagarajan, Ravi R.
AU - Becker, Lance B.
AU - Zhang, Chong
AU - Keenan, Heather T.
N1 - Funding Information:
Dr Tonna was supported by a career development award (K23HL141596) from the National Heart, Lung, and Blood Institute of the National Institutes of Health. This study was also indirectly supported in part by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-02 (formerly 8UL1TR000105 and UL1RR025764). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. None of the funding sources were involved in the design or conduct of the study, collection, management, analysis or interpretation of the data, or preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2020, American Heart Association Inc.. All rights reserved.
PY - 2020/5/5
Y1 - 2020/5/5
N2 - BACKGROUND: Outcomes from extracorporeal cardiopulmonary resuscitation (ECPR) are felt to be influenced by selective use, but the characteristics of those receiving ECPR are undefined. We demonstrate the relationship between individual patient and hospital characteristics and the probability of ECPR use. METHODS AND RESULTS: We performed an observational analysis of adult inpatient cardiac arrests in the United States from 2000 to 2018 reported to the American Heart Association’s Get With The Guidelines—Resuscitation registry restricted to hospitals that provided ECPR. We calculated case mix adjusted relative risk (RR) of receiving ECPR for individual characteristics. From 2000 to 2018, 129 736 patients had a cardiac arrest (128 654 conventional cardiopulmonary resuscitation and 1082 ECPR) in 224 hospitals that offered ECPR. ECPR use was associated with younger age (RR, 1.5 for <40 vs. 40–59 years; 95% CI, 1.2–1.8), no pre-existing comorbidities (RR, 1.4; 95% CI, 1.1–1.8) or cardiac-specific comorbidities (congestive heart failure [RR, 1.3; 95% CI, 1.2–1.5], prior myocardial infarction [RR, 1.4; 95% CI, 1.2–1.6], or current myocardial infarction [RR, 1.5; 95% CI, 1.3–1.8]), and in locations of procedural areas at the times of cardiac arrest (RR, 12.0; 95% CI, 9.5–15.1). ECPR decreased after hours (3–11 pm [RR, 0.8; 95% CI, 0.7–1.0] and 11 pm–7 am [RR, 0.6; 95% CI, 0.5–0.7]) and on weekends (RR, 0.7; 95% CI, 0.6–0.9). CONCLUSIONS: Less than 1% of in-hospital cardiac arrest patients are treated with ECPR. ECPR use is influenced by patient age, comorbidities, and hospital system factors. Randomized controlled trials are needed to better define the patients in whom ECPR may provide a benefit.
AB - BACKGROUND: Outcomes from extracorporeal cardiopulmonary resuscitation (ECPR) are felt to be influenced by selective use, but the characteristics of those receiving ECPR are undefined. We demonstrate the relationship between individual patient and hospital characteristics and the probability of ECPR use. METHODS AND RESULTS: We performed an observational analysis of adult inpatient cardiac arrests in the United States from 2000 to 2018 reported to the American Heart Association’s Get With The Guidelines—Resuscitation registry restricted to hospitals that provided ECPR. We calculated case mix adjusted relative risk (RR) of receiving ECPR for individual characteristics. From 2000 to 2018, 129 736 patients had a cardiac arrest (128 654 conventional cardiopulmonary resuscitation and 1082 ECPR) in 224 hospitals that offered ECPR. ECPR use was associated with younger age (RR, 1.5 for <40 vs. 40–59 years; 95% CI, 1.2–1.8), no pre-existing comorbidities (RR, 1.4; 95% CI, 1.1–1.8) or cardiac-specific comorbidities (congestive heart failure [RR, 1.3; 95% CI, 1.2–1.5], prior myocardial infarction [RR, 1.4; 95% CI, 1.2–1.6], or current myocardial infarction [RR, 1.5; 95% CI, 1.3–1.8]), and in locations of procedural areas at the times of cardiac arrest (RR, 12.0; 95% CI, 9.5–15.1). ECPR decreased after hours (3–11 pm [RR, 0.8; 95% CI, 0.7–1.0] and 11 pm–7 am [RR, 0.6; 95% CI, 0.5–0.7]) and on weekends (RR, 0.7; 95% CI, 0.6–0.9). CONCLUSIONS: Less than 1% of in-hospital cardiac arrest patients are treated with ECPR. ECPR use is influenced by patient age, comorbidities, and hospital system factors. Randomized controlled trials are needed to better define the patients in whom ECPR may provide a benefit.
KW - Cardiopulmonary resuscitation
KW - Extracorporeal cardiopulmonary resuscitation
KW - Extracorporeal life support
KW - Extracorporeal membrane oxygenation
KW - In-hospital cardiac arrest
KW - Resuscitation
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U2 - 10.1161/JAHA.119.015522
DO - 10.1161/JAHA.119.015522
M3 - Article
C2 - 32347147
AN - SCOPUS:85084273027
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e015522
ER -