Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan

Abstract Background We aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively analyzed the database of a multicente...

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Main Authors: Yohei Okada, Takeyuki Kiguchi, Taro Irisawa, Kazuhisa Yoshiya, Tomoki Yamada, Koichi Hayakawa, Kazuo Noguchi, Tetsuro Nishimura, Takuya Ishibe, Yoshiki Yagi, Masafumi Kishimoto, Hiroshi Shintani, Yasuyuki Hayashi, Taku Sogabe, Takaya Morooka, Haruko Sakamoto, Keitaro Suzuki, Fumiko Nakamura, Norihiro Nishioka, Tasuku Matsuyama, Junya Sado, Satoshi Matsui, Takeshi Shimazu, Kaoru Koike, Takashi Kawamura, Tetsuhisa Kitamura, Taku Iwami, on behalf of the CRITICAL Study Group Investigators
Format: Article
Language:English
Published: BMC 2020-05-01
Series:Journal of Intensive Care
Subjects:
Online Access:http://link.springer.com/article/10.1186/s40560-020-00451-6
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author Yohei Okada
Takeyuki Kiguchi
Taro Irisawa
Kazuhisa Yoshiya
Tomoki Yamada
Koichi Hayakawa
Kazuo Noguchi
Tetsuro Nishimura
Takuya Ishibe
Yoshiki Yagi
Masafumi Kishimoto
Hiroshi Shintani
Yasuyuki Hayashi
Taku Sogabe
Takaya Morooka
Haruko Sakamoto
Keitaro Suzuki
Fumiko Nakamura
Norihiro Nishioka
Tasuku Matsuyama
Junya Sado
Satoshi Matsui
Takeshi Shimazu
Kaoru Koike
Takashi Kawamura
Tetsuhisa Kitamura
Taku Iwami
on behalf of the CRITICAL Study Group Investigators
spellingShingle Yohei Okada
Takeyuki Kiguchi
Taro Irisawa
Kazuhisa Yoshiya
Tomoki Yamada
Koichi Hayakawa
Kazuo Noguchi
Tetsuro Nishimura
Takuya Ishibe
Yoshiki Yagi
Masafumi Kishimoto
Hiroshi Shintani
Yasuyuki Hayashi
Taku Sogabe
Takaya Morooka
Haruko Sakamoto
Keitaro Suzuki
Fumiko Nakamura
Norihiro Nishioka
Tasuku Matsuyama
Junya Sado
Satoshi Matsui
Takeshi Shimazu
Kaoru Koike
Takashi Kawamura
Tetsuhisa Kitamura
Taku Iwami
on behalf of the CRITICAL Study Group Investigators
Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
Journal of Intensive Care
Extracorporeal membrane oxygenation (ECMO)
Percutaneous cardiopulmonary support (PCPS)
Ventricular fibrillation
Extracorporeal life support
Blood gas assessment
author_facet Yohei Okada
Takeyuki Kiguchi
Taro Irisawa
Kazuhisa Yoshiya
Tomoki Yamada
Koichi Hayakawa
Kazuo Noguchi
Tetsuro Nishimura
Takuya Ishibe
Yoshiki Yagi
Masafumi Kishimoto
Hiroshi Shintani
Yasuyuki Hayashi
Taku Sogabe
Takaya Morooka
Haruko Sakamoto
Keitaro Suzuki
Fumiko Nakamura
Norihiro Nishioka
Tasuku Matsuyama
Junya Sado
Satoshi Matsui
Takeshi Shimazu
Kaoru Koike
Takashi Kawamura
Tetsuhisa Kitamura
Taku Iwami
on behalf of the CRITICAL Study Group Investigators
author_sort Yohei Okada
title Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
title_short Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
title_full Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
title_fullStr Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
title_full_unstemmed Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
title_sort association between low ph and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal cpr: a prospective observational cohort study in japan
publisher BMC
series Journal of Intensive Care
issn 2052-0492
publishDate 2020-05-01
description Abstract Background We aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively analyzed the database of a multicenter prospective observational study on OHCA patients in Osaka prefecture, Japan (CRITICAL study), from July 1, 2012 to December 31, 2016. We included adult OHCA patients treated by ECPR. Patients with OHCA from external causes such as trauma were excluded. We conducted logistic regression analysis to identify the odds ratio (OR) and 95% confidence interval (CI) of the pH value for 1 month favorable neurological outcome adjusted for potential confounders including sex, age, witnessed by bystander, CPR by bystander, pre-hospital initial cardiac rhythm, and cardiac rhythm on hospital arrival. Results Among the 9822 patients in the database, 260 patients were finally included in the analysis. The three groups were Tertile 1: pH ≥ 7.030, Tertile 2: pH 6.875–7.029, and Tertile 3: pH < 6.875. The adjusted OR of Tertiles 2 and 3 compared with Tertile 1 for 1 month favorable neurological outcome were 0.26 (95% CI 0.10–0.63) and 0.24 (95% CI 0.09–0.61), respectively. Conclusions This multi-institutional observational study showed that low pH value (< 7.03) before the implementation of ECPR was associated with 1 month unfavorable neurological outcome among OHCA patients treated with ECPR. It may be helpful to consider the candidate for ECPR.
topic Extracorporeal membrane oxygenation (ECMO)
Percutaneous cardiopulmonary support (PCPS)
Ventricular fibrillation
Extracorporeal life support
Blood gas assessment
url http://link.springer.com/article/10.1186/s40560-020-00451-6
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spelling doaj-6a6a9492743e48ea98761b2fe47e0ae92020-11-25T02:14:58ZengBMCJournal of Intensive Care2052-04922020-05-01811910.1186/s40560-020-00451-6Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in JapanYohei Okada0Takeyuki Kiguchi1Taro Irisawa2Kazuhisa Yoshiya3Tomoki Yamada4Koichi Hayakawa5Kazuo Noguchi6Tetsuro Nishimura7Takuya Ishibe8Yoshiki Yagi9Masafumi Kishimoto10Hiroshi Shintani11Yasuyuki Hayashi12Taku Sogabe13Takaya Morooka14Haruko Sakamoto15Keitaro Suzuki16Fumiko Nakamura17Norihiro Nishioka18Tasuku Matsuyama19Junya Sado20Satoshi Matsui21Takeshi Shimazu22Kaoru Koike23Takashi Kawamura24Tetsuhisa Kitamura25Taku Iwami26on behalf of the CRITICAL Study Group InvestigatorsDepartment of Preventive Services, School of Public Health, Kyoto UniversityKyoto University Health ServiceDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of MedicineDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of MedicineEmergency and Critical Care Medical Center, Osaka Police HospitalDepartment of Emergency and Critical Care Medicine, Takii Hospital, Kansai Medical UniversityDepartment of Emergency Medicine, Tane General HospitalDepartment of Critical Care Medicine, Osaka City UniversityDepartment of Emergency and Critical Care Medicine, Kindai University School of MedicineOsaka Mishima Emergency Critical Care CenterOsaka Prefectural Nakakawachi Medical Center of Acute MedicineSenshu Trauma and Critical Care CenterSenri Critical Care Medical Center, Saiseikai Senri HospitalTraumatology and Critical Care Medical Center, National Hospital Organization Osaka National HospitalEmergency and Critical Care Medical Center, Osaka City General HospitalDepartment of Pediatrics, Osaka Red Cross HospitalEmergency and Critical Care Medical Center, Kishiwada Tokushukai HospitalDepartment of Emergency and Critical Care Medicine, Kansai Medical UniversityDepartment of Preventive Services, School of Public Health, Kyoto UniversityDepartment of Emergency Medicine, Kyoto Prefectural University of MedicineDivision of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka UniversityDivision of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka UniversityDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of MedicineDepartment of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto UniversityDepartment of Preventive Services, School of Public Health, Kyoto UniversityDivision of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka UniversityDepartment of Preventive Services, School of Public Health, Kyoto UniversityAbstract Background We aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively analyzed the database of a multicenter prospective observational study on OHCA patients in Osaka prefecture, Japan (CRITICAL study), from July 1, 2012 to December 31, 2016. We included adult OHCA patients treated by ECPR. Patients with OHCA from external causes such as trauma were excluded. We conducted logistic regression analysis to identify the odds ratio (OR) and 95% confidence interval (CI) of the pH value for 1 month favorable neurological outcome adjusted for potential confounders including sex, age, witnessed by bystander, CPR by bystander, pre-hospital initial cardiac rhythm, and cardiac rhythm on hospital arrival. Results Among the 9822 patients in the database, 260 patients were finally included in the analysis. The three groups were Tertile 1: pH ≥ 7.030, Tertile 2: pH 6.875–7.029, and Tertile 3: pH < 6.875. The adjusted OR of Tertiles 2 and 3 compared with Tertile 1 for 1 month favorable neurological outcome were 0.26 (95% CI 0.10–0.63) and 0.24 (95% CI 0.09–0.61), respectively. Conclusions This multi-institutional observational study showed that low pH value (< 7.03) before the implementation of ECPR was associated with 1 month unfavorable neurological outcome among OHCA patients treated with ECPR. It may be helpful to consider the candidate for ECPR.http://link.springer.com/article/10.1186/s40560-020-00451-6Extracorporeal membrane oxygenation (ECMO)Percutaneous cardiopulmonary support (PCPS)Ventricular fibrillationExtracorporeal life supportBlood gas assessment