Extracorporreal CPR Linked With Preserved Neurological Functions in Some Patients: CRITICAL Study

Extracorporeal cardiopulmonary resuscitation (ECPR) may be a viable option for patients who do not respond to traditional CPR, a new analysis suggests.

“Standard CPR uses chest compressions to manually stimulate blood flow to vital organs, which can help limit long-term neurological damage,” lead author Tasuku Matsuyama, MD, said in a news release. “With ECPR, blood is removed from a vein and oxygenated blood is pumped into an artery. This is a more effective way to maintain tissue function until normal heart rhythms can be restored.”

The Comprehensive Registry of Intensive Cares for OHCA Survival (CRITICAL) study, published in Circulation, was a 14-center prospective cohort study in Japan that included 256 consecutive patients with out-of-hospital cardiac arrest. Patients had originally been given CPR by bystanders or EMS personnel before getting in-hospital treatment. The authors were looking to see whether low-flow duration (time between standard CPR and ECPR) affects neurological outcomes in OHCA patients, as well as whether patients with certain heart rhythms that responded to defibrillation derived any additional benefit from ECPR.

ECPR Can Help

The results suggested that as time to ECPR decreased, the odds of maintaining brain function were increased. The authors also reported that those with hearth rhythms responsive to defibrillation had a better chance of maintaining neurological function than those who did not respond.

Study limitations included the difficulty of measuring time from CPR to ECPR during OHCA, with the main results based on rough estimates. A difference in protocols for introducing ECPR between treatment centers was also cited as a limitation.

“Our study strongly indicates that reducing the time to ECPR can significantly improve the likelihood of OHCA patients preserving their neurological function, especially those who respond to defibrillation,” one authors said in a press release. “We expect that our findings in the CRITICAL study can inform future revisions to international CPR guidelines. This will improve outcomes for these patients.”