PULMONARY EMBOLISM RELATED REFRACTORY OUT-OF-HOSPITAL CARDIAC ARREST AND THE EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION: PRAGUE OHCA STUDY POST-HOC ANALYSIS. (YOUNG INVESTIGATOR AWARD COMPETITION)

Background
Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) is associated with poor outcomes. The role of extracorporeal cardiopulmonary resuscitation (ECPR) in this patient group is uncertain. This study aims to analyze clinical course, outcomes, and the effect of an invasive procedure, including ECPR, in a randomized population.
Methods
A post-hoc analysis of a randomized controlled trial (Prague OHCA study) was conducted to evaluate the effect of ECPR vs. a standard approach in r-OHCA. A subgroup of patients with PE-related r-OHCA was identified, and procedural and outcome characteristics, including favorable neurological survival, organ donation, and complications, were compared to patients without PE.
Results
PE was identified as a cause of r-OHCA in 24 of 256 (9.4%) enrolled patients. Patients with PE were more likely to be women (12/24 [50%] vs. 32/232 [13.8%]; p<0.001) and presented more frequently with an initial non-shockable rhythm (23/24 [95.8%] vs. 77/232 [33.2%]; p<0.001), as well as more severe acidosis at admission (median pH [interquartile range]; 6.83 [6.75-6.88] vs. 6.98 [6.82-7.14]; p<0.001). Their favorable 180 – days neurological survival was significantly lower (2/24 [8.3%] vs. 66/232 [28.4%]; P=0.049), but the proportion of accepted organ donors was higher (16.7 vs. 4.7 %, p=0.04).
Conclusion
r-OHCA due to PE has a different presentation and inferior outcomes compared to other causes but may represent an important source of organ donations. The ECPR method did not improve patient outcomes.