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Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest

By Currents Editor posted 04-14-2022 10:17


Journal of the American Medical Association (02/22/22); 327(8):737-747. DOI: 10.1001/jama.2022.1025
Belohlavek, Jan; Smalcova, Jana; Rob, Daniel; et al. 

The combination of early intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and invasive assessment and treatment did not significantly increase survival with neurologically favorable outcome at 180 days for patients with refractory out-of-hospital cardiac arrest (OHCA), compared with standard resuscitation, according to new research. The randomized clinical trial, which was conducted in Prague, included 256 adults (median age, 58 years; 17% women) with a witnessed OHCA without return of spontaneous circulation. The standard strategy group included 132 patients who received regular advanced cardiac life support that was continued on-site. The 124 patients in the invasive strategy group received mechanical compression, followed by intra-arrest transport to a cardiac center for extracorporeal cardiopulmonary resuscitation. In the primary analysis, 31.5% of the invasive strategy group (39 patients) achieved the primary outcome — survival to 180 days with good neurologic outcome, defined as Cerebral Performance Category 1-2 — compared with 22.0% of the standard strategy group (29 patients). That difference was not statistically significant. The study was stopped after enrolling 256 patients at the decision of the data and safety monitoring board, after prespecified criteria for futility were met. The researchers note there are limitations to the study, including the single-center design, the design allowed crossover, and that it may have been underpowered to detect a statistically significant difference for the primary outcome.


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