Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry)
Background The optimal low‐flow duration (LFD) for extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) remains unclear. We evaluated the impact of LFD on neurological outcomes based on initial cardiac rhythms and compared trends between ECPR and...
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| Language: | English |
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Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039938 |
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| author | Tasuku Matsuyama Bon Ohta Sho Komukai Sheldon Cheskes Steve Lin Rohit Mohindra Ian Drennan Johannes von Vopelius‐Feldt Tetsuhisa Kitamura |
| author_facet | Tasuku Matsuyama Bon Ohta Sho Komukai Sheldon Cheskes Steve Lin Rohit Mohindra Ian Drennan Johannes von Vopelius‐Feldt Tetsuhisa Kitamura |
| author_sort | Tasuku Matsuyama |
| collection | DOAJ |
| description | Background The optimal low‐flow duration (LFD) for extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) remains unclear. We evaluated the impact of LFD on neurological outcomes based on initial cardiac rhythms and compared trends between ECPR and CCPR. Methods This secondary analysis used data from a nationwide, prospective study of adult (≥18 years) nontraumatic patients with out‐of‐hospital cardiac arrest receiving cardiopulmonary resuscitation upon hospital arrival (June 2014–December 2019). LFD was defined as time from professional cardiopulmonary resuscitation initiation to ECPR initiation or return of spontaneous circulation/termination of resuscitation in CCPR. The primary outcome was 1‐month survival with favorable neurological status (Cerebral Performance Category scale 1 or 2). Patients were stratified into 4 groups based on first documented cardiac rhythm (pre‐ or in‐hospital). Results Among 42 365 patients (1355 ECPR, 36 991 CCPR), longer LFD was associated with poorer neurological outcomes in patients with initial shockable rhythms, regardless of ECPR or CCPR use. The highest favorable outcome rates were observed in the Shockable–Shockable groups (ECPR: 16.0%; CCPR: 16.9%), with a clear decline in outcomes as LFD increased (both P for trend <0.001). In contrast, this trend was absent in ECPR‐treated patients with initial nonshockable rhythms, who had consistently poor outcomes. Conclusions Longer LFD is associated with worse outcomes in patients with initial shockable rhythms. This association was not observed in nonshockable cases, although their prognosis was generally poor. Defining rhythm‐specific LFD thresholds may guide ECPR use and improve outcomes. |
| format | Article |
| id | doaj-art-ab14c5a5f5fd4975a9b552ed86de510d |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-ab14c5a5f5fd4975a9b552ed86de510d2025-08-20T03:13:00ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141410.1161/JAHA.124.039938Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry)Tasuku Matsuyama0Bon Ohta1Sho Komukai2Sheldon Cheskes3Steve Lin4Rohit Mohindra5Ian Drennan6Johannes von Vopelius‐Feldt7Tetsuhisa Kitamura8Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto JapanDepartment of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto JapanDepartment of Health Data Science Tokyo Medical University Tokyo JapanDepartment of Family and Community Medicine, Division of Emergency Medicine University of Toronto Toronto Ontario CanadaDepartment of Emergency Medicine St. Michael’s Hospital Toronto Toronto CanadaDepartment of Emergency Medicine North York General Hospital Toronto CanadaDepartment of Emergency Services and Sunnybrook Research Institute Sunnybrook Health Science Centre Toronto Ontario CanadaDepartment of Emergency Medicine St. Michael’s Hospital Toronto Toronto CanadaDivision of Environmental Medicine and Population Services, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka JapanBackground The optimal low‐flow duration (LFD) for extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) remains unclear. We evaluated the impact of LFD on neurological outcomes based on initial cardiac rhythms and compared trends between ECPR and CCPR. Methods This secondary analysis used data from a nationwide, prospective study of adult (≥18 years) nontraumatic patients with out‐of‐hospital cardiac arrest receiving cardiopulmonary resuscitation upon hospital arrival (June 2014–December 2019). LFD was defined as time from professional cardiopulmonary resuscitation initiation to ECPR initiation or return of spontaneous circulation/termination of resuscitation in CCPR. The primary outcome was 1‐month survival with favorable neurological status (Cerebral Performance Category scale 1 or 2). Patients were stratified into 4 groups based on first documented cardiac rhythm (pre‐ or in‐hospital). Results Among 42 365 patients (1355 ECPR, 36 991 CCPR), longer LFD was associated with poorer neurological outcomes in patients with initial shockable rhythms, regardless of ECPR or CCPR use. The highest favorable outcome rates were observed in the Shockable–Shockable groups (ECPR: 16.0%; CCPR: 16.9%), with a clear decline in outcomes as LFD increased (both P for trend <0.001). In contrast, this trend was absent in ECPR‐treated patients with initial nonshockable rhythms, who had consistently poor outcomes. Conclusions Longer LFD is associated with worse outcomes in patients with initial shockable rhythms. This association was not observed in nonshockable cases, although their prognosis was generally poor. Defining rhythm‐specific LFD thresholds may guide ECPR use and improve outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.124.039938cardiac rhythm transitionsconventional CPRECPRlow‐flow durationout‐of‐hospital cardiac arrest |
| spellingShingle | Tasuku Matsuyama Bon Ohta Sho Komukai Sheldon Cheskes Steve Lin Rohit Mohindra Ian Drennan Johannes von Vopelius‐Feldt Tetsuhisa Kitamura Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry) Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac rhythm transitions conventional CPR ECPR low‐flow duration out‐of‐hospital cardiac arrest |
| title | Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry) |
| title_full | Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry) |
| title_fullStr | Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry) |
| title_full_unstemmed | Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry) |
| title_short | Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry) |
| title_sort | extracorporeal and conventional cardiopulmonary resuscitation and low flow duration insights from a nationwide hospital based registry study in japan jaam ohca registry |
| topic | cardiac rhythm transitions conventional CPR ECPR low‐flow duration out‐of‐hospital cardiac arrest |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039938 |
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