Elsevier

Resuscitation

Volume 82, Issue 1, January 2011, Pages 10-14
Resuscitation

Clinical paper
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A review of the Japanese literature

https://doi.org/10.1016/j.resuscitation.2010.08.032Get rights and content

Abstract

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.

Section snippets

Study design

This study encompassed a review of the Japanese medical literature. The primary end point of this study was the survival rate at discharge of patients receiving ECPR. The secondary end point was neurological outcome at discharge as determined by the Glasgow Outcome Scale (GOS).

Data source and search strategy

Potentially relevant papers were identified and screened for retrieval by a thesaurus search. The search engine was the major Japanese databanks of ‘Igaku Chuou Zasshi (Japana Centra Revuo Medicina)’. The combined

Study population

According to the thesaurus search, 821 potentially relevant papers were identified and screened for retrieval. There were 1282 out-of-hospital cardiac arrest patients, who received ECPR as discussed in 105 articles (including 62 case series and 43 case reports) during the study period. A total of 139 cases were included in the in-depth analysis (Fig. 1).

Results

The baseline characteristics of cases, which included descriptions of specific elements, were as follows: the average age was 51 years (range, 4–88 years) in 722 cases; 419 patients (75.9%) were male and 133 (24.1%) were female in 552 cases; witnessed arrest was 90.7% (333 cases) of 367 cases; bystander CPR was performed in 234 (71.8%) of 326 cases; and cardiac aetiology was verified in 621 (48.4%) of 930 cases (Table 1).

As many as 54 papers, with the exception of 43 case reports presenting

Discussion

In our study, the survival rate at discharge was higher than that presented in the annual data in the official report of the Ambulance Service of the Fire Department in 2006 in Japan. The survival rate at 1 month was 8.5% of 18,320 cases of witnessed and cardiac-verified out-of-hospital cardiac arrest. Of these cases, the survival rate of patients of VF/pulseless VT was 20.5% (1049/5113). Although there might be different characteristics in each case included in the analysis, results from the

Conclusion

The study found that the influence of publication bias in published case series of ECPR in Japan was relatively low. The analysis indicated that ECPR could provide a higher survival rate with favourable neurological outcome in cases of out-of-hospital cardiac arrest.

Conflict of interest statement

No conflict of interests to declare.

Acknowledgements

This study was supported by grants from the Ministry of Health, Labour and Welfare, Japan. We gratefully thank Michi Sakai, MPH, Satoko Zenitani, MPH, MS, Sakurako Narita, MPH, Sachiko Ohta, MD, PhD, MS, FACP and Noriaki Aoki, MD, PhD, MS, MBA, FACP at Chord-J for their assistance in data collection.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.08.032.

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