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.

Basic information

Original name

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

Authors

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

Edition

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

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30218 General and internal medicine

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 120.700

RIV identification code

RIV/00216224:14110/22:00126152

Organization unit

Faculty of Medicine

DOI

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

UT WoS

000762147200020

Keywords in English

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

Abstract

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 and 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, vol. 327, No 8, p. 737-747. ISSN 0098-7484. Available from: 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 and 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, vol.~327, No~8, p.~737-747. ISSN~0098-7484. Available from: https://dx.doi.org/10.1001/jama.2022.1025.

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