A review of extracorporeal life support for out-of-hospital cardiac arrest was undertaken, looking specifically at studies published in the Japanese literature. The abstract is shown below. Based on these findings, inclusion criteria for a multicentre, prospective non-randomised cohort study were established. The ‘SAVE-J: Study of advanced life support for ventricular fibrillation with extracorporeal circulation in Japan’ was launched and has been ongoing since October 2008 to compare the proportion of patients with a favourable neurological outcome by intention-to-treat in an ECPR group with a non-ECPR group. Inclusion criteria for this new study are:
- shockable rhythm on the initial ECG
- cardiac arrest on arrival at hospital regardless of the presence of recovery of spontaneous circulation before arrival
- arrival at hospital within 45 min of the call for an ambulance or cardiac arrest;
- cardiac arrest remaining for more than 15 min after arrival at hospital.
I look forward to seeing the results SAVE-J. If you wish to read more, you can check out the SAVE-J study website.
AIM: Although favourable outcomes in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest have been frequently reported in Japanese journals since the late 1980s, there has been no meta-analysis of ECPR in Japan. This study reviewed and analysed all previous studies in Japan to clarify the survival rate of patients receiving ECPR.
MATERIAL AND METHODS: Case reports, case series and abstracts of scientific meetings of ECPR for out-of-hospital cardiac arrest written in Japanese between 1983 and 2008 were collected. The characteristics and outcomes of patients were investigated, and the influence of publication bias of the case-series studies was examined by the funnel-plot method.
RESULTS: There were 1282 out-of-hospital cardiac arrest patients, who received ECPR in 105 reports during the period. The survival rate at discharge given for 516 cases was 26.7±1.4%. The funnel plot presented the relationship between the number of cases of each report and the survival rate at discharge as the reverse-funnel type that centred on the average survival rate. In-depth review of 139 cases found that the rates of good recovery, mild disability, severe disability, vegetative state, death at hospital discharge and non-recorded in all cases were 48.2%, 2.9%, 2.2%, 2.9%, 37.4% and 6.4%, respectively.
CONCLUSIONS: Based on the results of previous reports with low publication bias in Japan, ECPR appears to provide a higher survival rate with excellent neurological outcome in patients with out-of-hospital cardiac arrest.
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a review of the Japanese literature
Resuscitation. 2011 Jan;82(1):10-4