Affiliation:
1. Division of Cardiothoracic Surgery Department of Surgery University of Utah Health Salt Lake City UT
2. Division of Emergency Medicine Department of Surgery University of Utah Health Salt Lake City UT
3. Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City IA
4. Division of Epidemiology Department of Medicine University of Utah Health Salt Lake City UT
5. Division of Cardiac Critical Care Boston Children’s Hospital Harvard Medical School Boston MA
6. Department of Emergency Medicine North Shore University Hospital Northwell Health System Manhasset NY
7. Division of Critical Care Department of Pediatrics University of Utah Health Salt Lake City UT
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
25 articles.
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