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CARDIAC RHYTHM CONVERSIONS AND THE OUTCOME IN REFRACTORY OUT-OF-HOSPITAL CARDIAC ARREST. COMPARISON OF EXTRACORPOREAL VS. CONVENTIONAL CARDIOPULMONARY RESUSCITATION.

Š. Havránek, J. Neuhofer, M. Vesela, P. Kaválková, D. Rob, Z. Fingrová, J. Šmalcová, O. Franěk, M. Huptych, M. Dusík, J. Pudil, A. Linhart, J. Bělohlávek (Praha)

Tématický okruh: Akutní stavy v kardiologii, Akutní koronární syndromy

Typ: Ústní sdělení - lékařské, CCVRID 2024

Background: Whether cardiac rhythm conversions during cardiopulmonary resuscitation (CPR) in refractory out-of hospital cardiac arrest (OHCA) affect outcome is not completely understood. A Prague OHCA study demonstrated that an invasive approach is a feasible and effective treatment strategy in refractory OHCA. In this post-hoc analysis of we aimed to stratify the outcome according to the detailed course of heart rhythm during pre-hospital period and compared in patients treated with extracorporeal vs. conventional CPR.
Methods: All patients randomized to Prague OHCA study were enrolled in this analysis. First documented, during the resuscitation and on admission heart rhythms were analyzed in relation to neurological outcome after 180 days in ECPR and conventionally resuscitated patients.
Results: Within the study cohort of 256 patients (median age 58y, 17% females), 156 (61%) manifested ventricle fibrillation, 45 (18%) asystole, and 55 (21%) pulseless electrical activity as an initial rhythm. Patients with an initial VF who reached a sustained recovery of spontaneous circulation (ROSC) had the highest proportion of reaching a primary outcome: 32/44 (73%). Conversely, no patient with an initial VF who converted to asystole as their on admission rhythm (24 pts) attained neurologically favorable outcome at 180 days; HR 3.44 (95% CI 1.76-6.74). Patients who experienced intermittent ROSC showed a higher success rate in achieving the primary outcome when treated with ECPR based approach compared to conventional strategy: 26 out of 34 (76%) versus 24 out of 50 (48%); p<0.05.
Conclusion: Rhythm conversions during CPR in refractory OHCA are associated with outcome, with Intermittent or sustained ROSC being the most favorable predictors. Patients presenting with VF with intermittent ROSC who remain in VF seem to be optimal candidates for an invasive approach.