Background
Methods
Data source and management
Participants
Exposure
Outcome
Data measurement, collection, and handling of missing data
Statistical analysis
Patient and hospital characteristics
Time-dependent propensity scores and sequential risk-set matching
Estimation of association between ECPR and outcomes
Results
Study flowchart and original cohort
Initial shockable rhythm | Initial non-shockable rhythm | |||||
---|---|---|---|---|---|---|
Characteristics | ECPR (N = 942) | Without ECPR (N = 2,108) | SMD | ECPR (N = 376) | Without ECPR (N = 29,855) | SMD |
Sex (men) | 811 (86%) | 1,652 (78%) | 0.20 | 289 (77%) | 17,167 (58%) | 0.42 |
Age | 59 (48, 68) | 69 (58, 79) | -0.68 | 60 (47, 69) | 79 (68, 86) | -1.2 |
Witnessed | 738 (78%) | 1,465 (69%) | 0.20 | 290 (77%) | 11,232 (38%) | 0.87 |
Bystander CPR | 522 (55%) | 1,076 (51%) | 0.09 | 164 (44%) | 14,350 (48%) | -0.09 |
Initial cardiac rhythm | 0.00 | 0.80 | ||||
Initial VF/VT | 942 (100%) | 2,108 (100%) | - | - | ||
PEA | - | - | 241 (64%) | 8,141 (27%) | ||
Asystole | - | - | 135 (36%) | 21,714 (73%) | ||
Bystander AED | 79 (8.4%) | 114 (5.4%) | 0.12 | 22 (5.9%) | 260 (0.9%) | 0.28 |
Physician-staffed heli/ambulance | 249 (26%) | 383 (18%) | 0.20 | 87 (23%) | 2,723 (9.1%) | 0.39 |
Shock by paramedic | 936 (99%) | 2,046 (97%) | 0.17 | 135 (36%) | 1,315 (4.4%) | 0.85 |
Advanced airway | 0.12 | 0.03 | ||||
Intubation | 122 (13%) | 201 (9.5%) | 36 (9.6%) | 3,084 (10%) | ||
None | 364 (39%) | 905 (43%) | 153 (41%) | 12,361 (41%) | ||
SGA | 456 (48%) | 1,002 (48%) | 187 (50%) | 14,410 (48%) | ||
Number of IV adrenaline | 0.10 | 0.17 | ||||
0 | 554 (59%) | 1,356 (64%) | 231 (61%) | 21,534 (72%) | ||
1 | 123 (13%) | 255 (12%) | 38 (10%) | 2,474 (8.3%) | ||
2 | 102 (11%) | 197 (9.3%) | 45 (12%) | 2,094 (7.0%) | ||
3 | 91 (9.7%) | 157 (7.4%) | 36 (9.6%) | 1,943 (6.5%) | ||
4 | 36 (3.8%) | 73 (3.5%) | 21 (5.6%) | 927 (3.1%) | ||
5 | 36 (3.8%) | 70 (3.3%) | 5 (1.3%) | 883 (3.0%) | ||
Pre-hospital ROSC | 73 (7.7%) | 238 (11%) | -0.12 | 30 (8.0%) | 1,048 (3.5%) | 0.19 |
Time from call to hospital | 31 (26, 39) | 32 (26, 40) | -0.08 | 33 (27, 40) | 33 (27, 40) | 0.00 |
Initial cardiac rhythm on arrival | 0.72 | 1.1 | ||||
Asystole | 154 (16%) | 770 (37%) | 111 (30%) | 22,622 (76%) | ||
PEA | 167 (18%) | 658 (31%) | 172 (46%) | 6,776 (23%) | ||
VF/VT | 621 (66%) | 680 (32%) | 93 (25%) | 457 (1.5%) | ||
Shock in hospital | 724 (77%) | 991 (47%) | 0.65 | 200 (53%) | 2,014 (6.7%) | 1.2 |
Adrenaline in hospital | 855 (91%) | 1,915 (91%) | 0.00 | 351 (93%) | 26,191 (88%) | 0.19 |
Intubation in hospital | 809 (86%) | 1,679 (80%) | 0.17 | 334 (89%) | 19,236 (64%) | 0.60 |
ECPR case volume | 0.51 | 0.55 | ||||
High volume | 688 (73%) | 1,122 (53%) | 274 (73%) | 15,765 (53%) | ||
Middle volume | 209 (22%) | 579 (27%) | 85 (23%) | 7,874 (26%) | ||
Low volume | 45 (4.8%) | 407 (19%) | 17 (4.5%) | 6,216 (21%) |
Matched cohort
Initial shockable rhythm | Initial non-shockable rhythm | |||||
---|---|---|---|---|---|---|
Characteristics | ECPR (N = 913) | Control (N = 913) | SMD | ECPR (N = 370) | Control (N = 370) | SMD |
Sex (men) | 784 (86%) | 778 (85%) | 0.02 | 284 (77%) | 278 (75%) | 0.04 |
Age | 59 (48, 68) | 59 (48, 70) | − 0.04 | 60 (47, 69) | 58 (45, 69) | 0.08 |
Witnessed | 714 (78%) | 717 (79%) | − 0.01 | 285 (77%) | 296 (80%) | − 0.07 |
Bystander CPR | 506 (55%) | 510 (56%) | − 0.01 | 160 (43%) | 178 (48%) | − 0.10 |
Initial cardiac rhythm | 0.00 | 0.01 | ||||
Initial VF/VT | 913 (100%) | 913 (100%) | – | – | ||
PEA | – | – | – | 237 (64%) | 239 (65%) | |
Asystole | – | – | – | 133 (36%) | 131 (35%) | |
Bystander AED | 77 (8.4%) | 74 (8.1%) | 0.01 | 20 (5.4%) | 20 (5.4%) | 0.00 |
Physician-staffed heli/ ambulance | 237 (26%) | 246 (27%) | − 0.02 | 86 (23%) | 105 (28%) | − 0.12 |
Shock by paramedic | 907 (99%) | 896 (98%) | 0.11 | 133 (36%) | 114 (31%) | 0.11 |
Advanced airway | 0.08 | 0.09 | ||||
Intubation | 121 (13%) | 126 (14%) | 35 (9.5%) | 41 (11%) | ||
None | 349 (38%) | 379 (42%) | 151 (41%) | 160 (43%) | ||
SGA | 443 (49%) | 408 (45%) | 184 (50%) | 169 (46%) | ||
Number of IV adrenaline | 0.02 | − 0.05 | ||||
0 | 533 (58%) | 538 (59%) | 226 (61%) | 212 (57%) | ||
1 | 121 (13%) | 135 (15%) | 38 (10%) | 56 (15%) | ||
2 | 99 (11%) | 93 (10%) | 44 (12%) | 48 (13%) | ||
3 | 91 (10.0%) | 72 (7.9%) | 36 (9.7%) | 22 (5.9%) | ||
4 | 33 (3.6%) | 34 (3.7%) | 21 (5.7%) | 10 (2.7%) | ||
≥ 5 | 36 (3.9%) | 41 (4.5%) | 5 (1.4%) | 22 (5.9%) | ||
Pre-hospital ROSC | 70 (7.7%) | 67 (7.3%) | 0.01 | 30 (8.1%) | 25 (6.8%) | 0.05 |
Time from call to hospital | 31 (26, 39) | 31 (25, 38) | 0.06 | 33 (27, 40) | 34 (27, 41) | − 0.03 |
Initial cardiac rhythm on arrival | 0.09 | 0.11 | ||||
Asystole | 151 (17%) | 133 (15%) | 110 (30%) | 104 (28%) | ||
PEA | 162 (18%) | 143 (16%) | 169 (46%) | 188 (51%) | ||
VF/VT | 600 (66%) | 637 (70%) | 91 (25%) | 78 (21%) | ||
Shock in hospital | 472 (52%) | 551 (60%) | − 0.17 | 133 (36%) | 133 (36%) | 0.00 |
Adrenaline in hospital | 776 (85%) | 838 (92%) | − 0.21 | 332 (90%) | 346 (94%) | − 0.14 |
Intubation in hospital | 711 (78%) | 761 (83%) | − 0.14 | 303 (82%) | 323 (87%) | − 0.15 |
ECPR case volume | 0.12 | 0.19 | ||||
High volume | 668 (73%) | 664 (73%) | 269 (73%) | 277 (75%) | ||
Middle volume | 202 (22%) | 181 (20%) | 85 (23%) | 64 (17%) | ||
Low volume | 43 (4.7%) | 68 (7.4%) | 16 (4.3%) | 29 (7.8%) |