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 A Randomized Clinical
Trial

J 2022

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 A Randomized Clinical Trial

BELOHLAVEK, Jan, Jana SMALCOVA, Daniel ROB, Ondrej FRANEK, Ondrej SMID et. al.

Základní údaje

Originální název

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 A Randomized Clinical Trial

Autoři

BELOHLAVEK, Jan (203 Česká republika, garant), Jana SMALCOVA (203 Česká republika), Daniel ROB (203 Česká republika), Ondrej FRANEK (203 Česká republika), Ondrej SMID (203 Česká republika), Milana POKORNA (203 Česká republika), Jan HORAK (203 Česká republika), Vratislav MRAZEK (203 Česká republika), Tomas KOVARNIK (203 Česká republika), David ZEMANEK (203 Česká republika), Ales KRAL (203 Česká republika), Stepan HAVRANEK (203 Česká republika), Petra KAVALKOVA (203 Česká republika), Lucie KOMPELENTOVA (203 Česká republika), Helena TOMKOVA (203 Česká republika), Alan MEJSTRIK (203 Česká republika), Jaroslav VALASEK (203 Česká republika), David PERAN (203 Česká republika), Jaroslav PEKARA (203 Česká republika), Jan RULISEK (203 Česká republika), Martin BALIK (203 Česká republika), Michal HUPTYCH (203 Česká republika), Jiří JARKOVSKÝ (203 Česká republika, domácí), Jan MALIK (203 Česká republika), Anna VALERIANOVA (203 Česká republika), Frantisek MLEJNSKY (203 Česká republika), Petr KOLOUCH (203 Česká republika), Petra HAVRANKOVA (203 Česká republika), Dan ROMPORTL (203 Česká republika), Arnost KOMAREK (203 Česká republika) a Ales LINHART (203 Česká republika)

Vydání

JAMA-Journal of the American Medical Association, Chicago, USA, American Medical Association, 2022, 0098-7484

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30218 General and internal medicine

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 120.700

Kód RIV

RIV/00216224:14110/22:00126152

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1001/jama.2022.1025

UT WoS

000762147200020

Klíčová slova anglicky

Intra-arrest Transport; Extracorporeal Cardiopulmonary Resuscitation; Immediate Invasive Assessment and Treatment; Functional Neurologic Outcome

Štítky

14119612, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 28. 6. 2022 10:54, Mgr. Tereza Miškechová

Anotace

V originále

IMPORTANCE Out-of-hospital cardiac arrest (OHCA) has poor outcome. Whether intra-arrest transport, extracorporeal cardiopulmonary resuscitation (ECPR), and immediate invasive assessment and treatment (invasive strategy) is beneficial in this setting remains uncertain. OBJECTIVE To determine whether an early invasive approach in adults with refractory OHCA improves neurologically favorable survival. DESIGN, SETTING, AND PARTICIPANTS Single-center, randomized clinical trial in Prague, Czech Republic, of adults with a witnessed OHCA of presumed cardiac origin without return of spontaneous circulation. A total of 256 participants, of a planned sample size of 285, were enrolled between March 2013 and October 2020. Patients were observed until death or day 180 (last patient follow-up ended on March 30, 2021). INTERVENTIONS In the invasive strategy group (n = 124), mechanical compression was initiated, followed by intra-arrest transport to a cardiac center for ECPR and immediate invasive assessment and treatment. Regular advanced cardiac life support was continued on-site in the standard strategy group (n = 132). MAIN OUTCOMES AND MEASURES The primary outcome was survival with a good neurologic outcome (defined as Cerebral Performance Category [CPC] 1-2) at 180 days after randomization. Secondary outcomes included neurologic recovery at 30 days (defined as CPC 1-2 at any time within the first 30 days) and cardiac recovery at 30 days (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours). RESULTS The trial was stopped at the recommendation of the data and safety monitoring board when prespecified criteria for futility were met. Among 256 patients (median age, 58 years; 44 [17%] women), 256 (100%) completed the trial. 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 (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 2.47]; difference, 9.4% [95% CI, -2.5% to 21%]; P = .12). Bleeding occurred more frequently in the invasive strategy vs standard strategy group (31% vs 15%, respectively). CONCLUSIONS AND RELEVANCE Among patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation. However, the trial was possibly underpowered to detect a clinically relevant difference.

Citovat

BELOHLAVEK, Jan, Jana SMALCOVA, Daniel ROB, Ondrej FRANEK, Ondrej SMID, Milana POKORNA, Jan HORAK, Vratislav MRAZEK, Tomas KOVARNIK, David ZEMANEK, Ales KRAL, Stepan HAVRANEK, Petra KAVALKOVA, Lucie KOMPELENTOVA, Helena TOMKOVA, Alan MEJSTRIK, Jaroslav VALASEK, David PERAN, Jaroslav PEKARA, Jan RULISEK, Martin BALIK, Michal HUPTYCH, Jiří JARKOVSKÝ, Jan MALIK, Anna VALERIANOVA, Frantisek MLEJNSKY, Petr KOLOUCH, Petra HAVRANKOVA, Dan ROMPORTL, Arnost KOMAREK a Ales LINHART. 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 A Randomized Clinical Trial. JAMA-Journal of the American Medical Association. Chicago, USA: American Medical Association, 2022, roč. 327, č. 8, s. 737-747. ISSN 0098-7484. Dostupné z: https://dx.doi.org/10.1001/jama.2022.1025.

@article{1863089,
   author = {Belohlavek, Jan and Smalcova, Jana and Rob, Daniel and Franek, Ondrej and Smid, Ondrej and Pokorna, Milana and Horak, Jan and Mrazek, Vratislav and Kovarnik, Tomas and Zemanek, David and Kral, Ales and Havranek, Stepan and Kavalkova, Petra and Kompelentova, Lucie and Tomkova, Helena and Mejstrik, Alan and Valasek, Jaroslav and Peran, David and Pekara, Jaroslav and Rulisek, Jan and Balik, Martin and Huptych, Michal and Jarkovský, Jiří and Malik, Jan and Valerianova, Anna and Mlejnsky, Frantisek and Kolouch, Petr and Havrankova, Petra and Romportl, Dan and Komarek, Arnost and Linhart, Ales},
   article_location = {Chicago, USA},
   article_number = {8},
   doi = {http://dx.doi.org/10.1001/jama.2022.1025},
   keywords = {Intra-arrest Transport; Extracorporeal Cardiopulmonary Resuscitation; Immediate Invasive Assessment and Treatment; Functional Neurologic Outcome},
   language = {eng},
   issn = {0098-7484},
   journal = {JAMA-Journal of the American Medical Association},
   title = {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 A Randomized Clinical Trial},
   url = {https://jamanetwork.com/journals/jama/fullarticle/2789313},
   volume = {327},
   year = {2022}
}

TY  - JOUR
ID  - 1863089
AU  - Belohlavek, Jan - Smalcova, Jana - Rob, Daniel - Franek, Ondrej - Smid, Ondrej - Pokorna, Milana - Horak, Jan - Mrazek, Vratislav - Kovarnik, Tomas - Zemanek, David - Kral, Ales - Havranek, Stepan - Kavalkova, Petra - Kompelentova, Lucie - Tomkova, Helena - Mejstrik, Alan - Valasek, Jaroslav - Peran, David - Pekara, Jaroslav - Rulisek, Jan - Balik, Martin - Huptych, Michal - Jarkovský, Jiří - Malik, Jan - Valerianova, Anna - Mlejnsky, Frantisek - Kolouch, Petr - Havrankova, Petra - Romportl, Dan - Komarek, Arnost - Linhart, Ales
PY  - 2022
TI  - 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 A Randomized Clinical Trial
JF  - JAMA-Journal of the American Medical Association
VL  - 327
IS  - 8
SP  - 737-747
EP  - 737-747
PB  - American Medical Association
SN  - 00987484
KW  - Intra-arrest Transport
KW  - Extracorporeal Cardiopulmonary Resuscitation
KW  - Immediate Invasive Assessment and Treatment
KW  - Functional Neurologic Outcome
UR  - https://jamanetwork.com/journals/jama/fullarticle/2789313
N2  - IMPORTANCE Out-of-hospital cardiac arrest (OHCA) has poor outcome. Whether intra-arrest transport, extracorporeal cardiopulmonary resuscitation (ECPR), and immediate invasive assessment and treatment (invasive strategy) is beneficial in this setting remains uncertain. OBJECTIVE To determine whether an early invasive approach in adults with refractory OHCA improves neurologically favorable survival. DESIGN, SETTING, AND PARTICIPANTS Single-center, randomized clinical trial in Prague, Czech Republic, of adults with a witnessed OHCA of presumed cardiac origin without return of spontaneous circulation. A total of 256 participants, of a planned sample size of 285, were enrolled between March 2013 and October 2020. Patients were observed until death or day 180 (last patient follow-up ended on March 30, 2021). INTERVENTIONS In the invasive strategy group (n = 124), mechanical compression was initiated, followed by intra-arrest transport to a cardiac center for ECPR and immediate invasive assessment and treatment. Regular advanced cardiac life support was continued on-site in the standard strategy group (n = 132). MAIN OUTCOMES AND MEASURES The primary outcome was survival with a good neurologic outcome (defined as Cerebral Performance Category [CPC] 1-2) at 180 days after randomization. Secondary outcomes included neurologic recovery at 30 days (defined as CPC 1-2 at any time within the first 30 days) and cardiac recovery at 30 days (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours). RESULTS The trial was stopped at the recommendation of the data and safety monitoring board when prespecified criteria for futility were met. Among 256 patients (median age, 58 years; 44 [17%] women), 256 (100%) completed the trial. 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 (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 2.47]; difference, 9.4% [95% CI, -2.5% to 21%]; P = .12). Bleeding occurred more frequently in the invasive strategy vs standard strategy group (31% vs 15%, respectively). CONCLUSIONS AND RELEVANCE Among patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation. However, the trial was possibly underpowered to detect a clinically relevant difference.
ER  -

BELOHLAVEK, Jan, Jana SMALCOVA, Daniel ROB, Ondrej FRANEK, Ondrej SMID, Milana POKORNA, Jan HORAK, Vratislav MRAZEK, Tomas KOVARNIK, David ZEMANEK, Ales KRAL, Stepan HAVRANEK, Petra KAVALKOVA, Lucie KOMPELENTOVA, Helena TOMKOVA, Alan MEJSTRIK, Jaroslav VALASEK, David PERAN, Jaroslav PEKARA, Jan RULISEK, Martin BALIK, Michal HUPTYCH, Jiří JARKOVSKÝ, Jan MALIK, Anna VALERIANOVA, Frantisek MLEJNSKY, Petr KOLOUCH, Petra HAVRANKOVA, Dan ROMPORTL, Arnost KOMAREK a Ales LINHART. 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 A Randomized Clinical Trial. \textit{JAMA-Journal of the American Medical Association}. Chicago, USA: American Medical Association, 2022, roč.~327, č.~8, s.~737-747. ISSN~0098-7484. Dostupné z: https://dx.doi.org/10.1001/jama.2022.1025.

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