The following is a summary of “Extracorporeal cardiopulmonary resuscitation location, coronary angiography and survival in out-of-hospital cardiac arrest,” published in the December 2022 issue of Emergency Medicine by Kim, et al.

Extracorporeal cardiopulmonary resuscitation (ECPR) should always be performed in a timely and safe manner, however, the ideal site was still unknown. For a study, researchers sought to assess the relationship between the site of ECPR and patients who had experienced an out-of-hospital cardiac arrest (OHCA). They also investigated whether individuals who received coronary angiography (CAG) vs. those who did not experience different effects of ECPR placement on survival.

They used information gathered from a national OHCA database between 2013 and 2020. The research comprised adult OHCA patients who received ECPR and were thought to have a cardiac cause. The main result was making it to discharge. The ECPR site was the primary exposure (emergency department [ED] or cardiac catheterization laboratory [Cath lab]). Using multivariable logistic regression, they evaluated the major outcomes of ECPR between the ED and Cath lab. Additionally assessed was the relationship between CAG and ECPR location.

Of the 564 patients that received ECPR, 448 (79.4%) and 116 (20.6%) did so in the ED and the Cath lab, respectively. In the ED and Cath lab groups, CAG was found in 52.5% and 72.4% of the patients. Between the ED and Cath lab groups (14.1% vs. 12.9%, p = 0.75, adjusted odds ratio [AOR] [95% CI] 1.87 [0.85–4.11]), there were no appreciable differences in survival to discharge. Patients with CAG had an AOR of interaction analysis (95% CI) of 2.34 (1.02-5.40), while patients without CAG had an AOR of 0.28 (0.04-1.84) for survival to discharge in the ED group (p for interaction was 0.04).

Compared to ECPR performed in a cath lab, ECPR performed in the ED sped up the time it took for the ECMO pump to turn on and enhanced survival to discharge in adult OHCA patients who had both ECPR and CAG.

Reference: sciencedirect.com/science/article/pii/S0735675722007100