Association between increasing institutional experience with ECPR and outcomes in patients with out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM-OHCA registry)

Aim: To determine the association between institutional experience with extracorporeal cardiopulmonary resuscitation (ECPR) and outcomes after out-of-hospital cardiac arrest (OHCA).

Methods: We analyzed data from the JAAM-OHCA registry, a nationwide multicenter database containing information on patients who experienced OHCA in Japan between June 2014 and December 2020. The study population consisted of patients with OHCA who were in cardiac arrest on hospital arrival and treated with extracorporeal membrane oxygenation (ECMO). Each patient was assigned a sequential number based on the order of initiation of ECPR at each facility. The primary outcome was 30-day survival and the secondary outcome was the interval between hospital admission and initiation of ECMO.

Results: Data for a total of 2,315 patients with OHCA and cardiac arrest on hospital arrival who were treated with ECPR at any of 87 facilities were analyzed. On admission, 1,047 patients had shockable rhythm and 1,268 had non-shockable rhythm. The 30-day survival rate was not significantly associated with the accumulated case volume of ECPR. The interval between hospital arrival and initiation of ECMO decreased significantly with increasing experience of ECPR (p < 0.001, Jonckheere-Terpstra test). In non-shockable cases, 30-day survival tended to improve with increasing experience of ECPR (p = 0.04, Cochran-Armitage trend test).

Conclusion: Increasing institutional experience of ECPR did not significantly improve 30-day survival after OHCA but was associated with a shorter interval between hospital arrival and initiation of ECMO. In patients with non-shockable OHCA, increasing experience of ECPR improved 30-day survival. (246/250 words).