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Patient and institutional characteristics influence the decision to use extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest
Open accessAbstract
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.
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Across 224 North American hospitals participating in the AHA Get-with-the-Guidelines-Resuscitation-registry, fewer than 1% of patients received E-CPR between 2000 and 2018.
“Across 224 North American hospitals that participate in the American Heart Association (AHA) Get-with-the-Guidelines-Resuscitation-registry, fewer than 1% patients received E-CPR between 2000 and 2018, indicating a further need for optimised patient selection and E-CPR implementation strategies. 170,171”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [170]
The Abstract (Methods and Results) reports 1,082 ECPR recipients among 129,736 cardiac-arrest patients at 224 hospitals from 2000 to 2018—fewer than 1%. The study population was specifically adults with in-hospital cardiac arrest at US hospitals that offered ECPR, not patients generally across North American registry hospitals. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCardiac arrest patients may meet criteria for both uncontrolled donation and E-CPR programmes.
“Cardiac arrest patients may meet criteria for both uncontrolled donation and E-CPR programmes. 157,159,179”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [179]
The Methods and Discussion describe which in-hospital cardiac arrest patients received ECPR, but do not address eligibility for uncontrolled donation or overlap between the two programmes. A search of our copy for uncontrolled donation and organ donation found no passage addressing that overlap; page numbers were not available. (LLM, conf=0.76)
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European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions
Mentzelopoulos, S. D., Couper, K., Voorde, P. V. D., Druwé, P., Blom, M., Perkins, G. D., Lulic, I., Djakow, J., Raffay, V., Lilja, G., et al. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.02.017 · Cited by 246
“Across 224 North American hospitals that participate in the American Heart Association (AHA) Get-with-the-Guidelines-Resuscitation-registry, fewer than 1% patients received E-CPR between 2000 and 2018, indicating a further need for optimised patient selection and E-CPR implementation strategies.(170,171) One systemati…”
Background
Metadata
- Authors
- Tonna, J. E., Selzman, C. H., Girotra, S., Presson, A. P., Thiagarajan, R. R., Becker, L. B., Zhang, C., Keenan, H. T., & the American Heart Association's Get With the Guidelines—Resuscitation Investigators
- Affiliations
- University of Utah (US)
- University of Iowa (US)
- Boston Children's Hospital (US)
- Northwell Health (US)
- Corresponding author
- Tonna, Joseph E.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2020-05-05
- Volume
- 9
- Issue
- 9
- Pages
- e015522-e015522
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7428578
- OpenAlex
- W3018080731
- Cited by
- 56
- References
- 2
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 12 · 2023: 7 · 2022: 19 · 2021: 7
- FWCI
- 7.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health (5ul1tr001067-05, UL1TR002538, UL1TR000105)
- National Heart, Lung, and Blood Institute (K23HL141596)
- National Center for Research Resources (UL1RR025764)
- National Center for Advancing Translational Sciences (UL1-TR001067)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- extracorporeal cardiopulmonary resuscitation, in-hospital cardiac arrest, patient characteristics, hospital characteristics, comorbidities, congestive heart failure, myocardial infarction, patient age, weekend effect, time of day, case mix, resource allocation, end-of-life decisions
- MeSH terms
- Clinical Decision-Making, Adult, Age Factors, Female, Heart Arrest, Hospitalization, Humans, Male, Middle Aged, Registries, Risk Factors, Time Factors, United States, Extracorporeal Membrane Oxygenation, Comorbidity, Cardiology Service, Hospital, Cardiopulmonary Resuscitation, Treatment Outcome, Risk Assessment, Patient Selection, After-Hours Care
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