For a study, researchers sought to determine if an early invasive treatment improved neurologically favorable survival in adults with refractory OHCA. Patients with an observed OHCA of assumed cardiac origin and no recovery of spontaneous circulation were included in a single-center, randomized clinical study. Between March 2013 and October 2020, 256 people were enrolled out of a total sample size of 285. Patients were monitored until they died or reached the age of 180. (last patient follow-up ended on March 30, 2021). Mechanical compression was commenced in the invasive approach group (n=124), followed by intra-arrest transfer to a cardiac facility for ECPR and prompt invasive examination and therapy. In the conventional approach group (n=132), regular advanced cardiac life support was maintained on-site. At 180 days following randomization, the primary outcome was survival with a favorable neurologic result (defined as Cerebral Performance Category [CPC] 1-2). Secondary outcomes were 30-day neurologic recovery (defined as CPC 1-2 at any point during the first 30 days) and 30-day cardiac recovery (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours).
When predefined futility criteria were fulfilled, the experiment was halted at the advice of the data and safety monitoring board. The experiment was completed by 256 patients (median age, 58 years; 44 [17%] women). In the main analysis, 39 patients (31.5%) in the invasive strategy group and 29 (22.0%) in the standard strategy group survived to 180 days with good neurologic outcome (odds ratio [OR], 1.63 [95% CI, 0.93 to 2.85]; difference, 9.5% [95% CI, 1.3% to 20.1%]; P=.09). At 30 days, neurologic recovery had occurred in 38 patients (30.6%) in the invasive strategy group and in 24 patients (18.2%) in the standard strategy group (OR, 1.99 [95% CI, 1.11 to 3.57]; difference, 12.4% [95% CI, 1.9% to 22.7%]; P=.02), and cardiac recovery had occurred in 54 (43.5%) and 45 (34.1%) patients, respectively (OR, 1.49 [95% CI, 0.91 to Bleeding was more common in the intrusive strategy group than in the conventional strategy group (31% vs 15%, respectively).
When compared to routine resuscitation, the bundle of early intra-arrest transfer, ECPR, and invasive examination and therapy did not substantially enhance survival with neurologically good results at 180 days in patients with refractory out-of-hospital cardiac arrest.
Reference:jamanetwork.com/journals/jama/article-abstract/2789313
