Table 3. Additional Outcomes Related to Transport, Hospitalization, and Intervention in a Study of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment in Refractory Out-of-Hospital Cardiac Arrest.
| Prehospital and early hospital events | No. (%) | |
|---|---|---|
| Invasive strategy (n = 124) | Standard strategy (n = 132) | |
| Arrived to hospital | 123 (99) | 87 (66) |
| Time from collapse to hospital arrival, median (IQR), min | 49 (44-60) | 60 (50-69) |
| Transport time - time from randomization to admission, median (IQR), min | 26 (19-33) | 33 (25-42) |
| Prehospital declaration of death | 1 (1) | 45 (34) |
| Declaration of death within 1 h of hospital admission | 10 (8) | 19 (14) |
| Time of CPR (time to death/ROSC or ECLS), median (IQR), min | 58 (43-70) | 46 (33-68) |
| Duration of CPR, min | ||
| <30 | 14 (11) | 26 (20) |
| ≥30 and <45 | 19 (15) | 33 (25) |
| ≥45 | 91 (73) | 73 (55) |
| Sustained ROSC on admissiona | 34 (27) | 58 (44) |
| Hospitalization events | ||
| Target temperature management used, No./total (%)b | 117/123 (95) | 61/87 (70) |
| Extracorporeal life support | ||
| ECLS implanted | 82 (66) | 10 (8) |
| Time to ECLS, median (IQR), min | 61 (55-70) [n = 81] | 62 (51-73) [n = 10] |
| Time of implantation (door to ECLS), median (IQR), min | 12 (9-15) [n = 80] | 16 (11-17) [n = 10] |
| Invasive assessment, No./total (%) | ||
| Diagnostic angiography | 120/123 (98) | 67/87 (77) |
| Coronary angiography | 115/120 (96) | 66/67 (99) |
| Aortography | 28/120 (24) | 13/67 (19) |
| Left ventricle angiography | 26/120 (22) | 21/67 (31) |
| Pulmonary angiography | 22/120 (18) | 5/67 (8) |
| Emergency invasive interventions, No./total (%) | ||
| PCI (both for ACS and CAD)c | ||
| Successful | 56/62 (90) | 24/30 (80) |
| Unsuccessful | 6/62 (10) | 6/30 (20) |
| Balloon valvuloplasty | 0/120 | 3 (4) |
| Laboratory values on admission | ||
| pH [reference, 7.36-7.44], median (IQR) | 6.93 (6.8-7.1) | 7.03 (6.9-7.2) |
| Lactate [reference, 0.5-2.0], median (IQR), mmol/L | 12.5 (9.2-16) | 10.4 (7.5-13.5) |
| Cause of cardiac arrest (including autopsy findings) | ||
| Acute coronary syndrome | 64 (52) | 63 (48) |
| Coronary artery disease-chronic | 14 (11) | 18 (14) |
| Pulmonary embolism | 12 (10) | 12 (9) |
| Chronic heart failure | 8 (7) | 6 (5) |
| Myocarditis | 6 (5) | 2 (2) |
| Accidental hypothermia | 3 (2) | 1 (1) |
| Bleeding-other | 3 (2) | 0 |
| Cardiomyopathy | 3 (2) | 6 (5) |
| Unknown | 3 (2) | 12 (9) |
| Aortic stenosis | 2 (2) | 6 (5) |
| Aortic dissection type A | 2 (2) | 2 (2) |
| Pulmonary hypertension | 2 (2) | 0 |
| Intracranial hemorrhage | 1 (1) | 2 (2) |
| Other | 1 (1) | 1 (1) |
| Sepsis | 0 | 1 (1) |
| Cause of death | ||
| No. | 84 | 101 |
| Multiple organ failure | 35 (42) | 17 (17) |
| Brain death | 21 (25) | 9 (9) |
| Refractory arrest | 13 (16) | 67 (66) |
| Cardiogenic shock | 10 (12) | 4 (4) |
| Bleeding | 4 (5) | 0 |
| Unknown | 1 (1) | 4 (4) |
| Withdrawal of life-sustaining therapy | 21 (17) | 14 (11) |
| Evaluated for organ donationd | 21 (17) | 3 (2) |
| Accepted for organ donation | 13 (11) | 2 (2) |
| Complications/other events, No./total (%) | ||
| Bleeding—anye | 36/116 (31) | 10/69 (15) |
| Overt | 24/36 (67) | 8/10 (80) |
| Intracranial hemorrhage | 8/36 (22) | 2/10 (20) |
| Fatal | 4/36 (11) | 0/10 |
| Organ lacerations | 4/114 (4) | 3/103 (3) |
| Technicalf | 3/124 (2) | 0/132 |
Abbreviations: ACS, acute coronary syndrome; CAD, coronary artery disease; CPC, cerebral performance category; CPR, cardiopulmonary resuscitation; ECLS, extracorporeal life support; MOF, multiple organ failure syndrome; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation.
Defined as a palpable pulse with organized ECG rhythm for at least 20 minutes.
Target temperature management indicates all cooling categories, including intravascular and surface feedback device cooling and ECLS heat exchanger cooling.
PCI was deemed successful if resulting in residual stenosis of less than 50% with Thrombolysis in Myocardial Infarction grade 2 or 3 flow.
Evaluation by the transplant center as a potential donor.
Bleeding complications were assessed based on Thrombolysis in Myocardial Infarction classification21 under “major” category, defined as any intracranial hemorrhage (excluding microhemorrhages <10 mm), fatal bleeding directly resulting in death within 7 days, or overt bleeding associated with a decrease in hemoglobin concentration of 5 g/dL or a 15% absolute decrease in hematocrit.
Any device failures during periresuscitation care, mainly focused on extracorporeal life support components.