Intra-Aortic Balloon Pump among Shockable Out-of-Hospital Cardiac Arrest Patients: A Propensity-Weighted Analysis in a Multicenter, Nationwide Observational Study in Japan (The JAAM-OHCA Registry)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Patients
2.3. Emergency Medical Services in Japan
2.4. Data Collection and Quality Control
2.5. Outcome Measures
2.6. Sample Size Estimation and Missing Value
2.7. Statistical Analysis
3. Results
4. Discussion
4.1. Summary
4.2. Comparison with Previous Studies
4.3. Possible Explanation and Implications
4.4. Limitation
5. Conclusions
6. Patents
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Original Cohort | |||||
---|---|---|---|---|---|
With IABP | Without IABP | Missing (%) | SMD | SMD (IPW) | |
(N = 960) | (N = 1778) | ||||
Year, n(%) | 0.051 | 0.015 | |||
2014 | 74 (7.7) | 134 (7.5) | 0 | ||
2015 | 143 (14.9) | 297 (16.7) | 0 | ||
2016 | 166 (17.3) | 317 (17.8) | 0 | ||
2017 | 177 (18.4) | 343 (19.3) | 0 | ||
2018 | 210 (21.9) | 358 (20.1) | 0 | ||
2019 | 190 (19.8) | 329 (18.5) | 0 | ||
Age, years, median (IQR) | 63.00 [52.00, 71.00] | 66.00 [54.00, 76.00] | 0 | 0.215 | 0.04 |
Men, n (%) | 816 (85.0) | 1373 (77.2) | 0 | 0.2 | 0.007 |
Witness status, n (%) | 395/100 (79.8/20.2) | 384 (73.0) | 0 | 0.021 | 0.039 |
Bystander CPR | 538 (56.0) | 1012 (56.9) | 0 | 0.018 | 0.009 |
Adrenaline administration at pre-hospital, n (%) | 323 (33.6) | 456 (25.6) | 21.5 | 0.173 | 0.031 |
Tracheal intubation, n (%) | 480 (61.1) | 687 (50.4) | 0 | 0.274 | 0.001 |
First documented rhythm after hospital arrival | 0 | 0.631 | 0.004 | ||
shockable | 457 (47.6) | 399 (22.4) | 0 | ||
non-shockable | 292 (30.4) | 543 (30.5) | 0 | ||
presence of pulse | 211 (22.0) | 836 (47.0) | 0 | ||
Time from call to hospital arrival, mins, median (IQR) | 30.00 [25.00, 37.00] | 30.00 [25.00, 37.00] | 0.7 | 0.084 | 0.033 |
Adrenaline administration at in-hospital, n (%) | 704 (73.3) | 847 (47.6) | 0 | 0.545 | 0.041 |
Coronary angiography, n (%) | 924 (96.2) | 942 (53.0) | 0 | 1.145 | 0 |
Target temperature management, n (%) | 614 (64.0) | 748 (42.1) | 0 | 0.449 | 0.071 |
Extracorporeal membrane oxygenation, n (%) | 662 (69.0) | 262 (14.7) | 0 | 1.315 | 0.003 |
Cardiac cause, n (%) | 946 (98.5) | 1684 (94.7) | 0 | 0.213 | 0.011 |
PS-Matched Cohort | ||||
---|---|---|---|---|
With IABP | Without IABP | Missing (%) | SMD | |
(N = 468) | (N = 468) | |||
Year, n(%) | ||||
2014 | 39 (8.3) | 40 (8.5) | 0 | −0.007 |
2015 | 78 (16.7) | 71 (15.2) | 0 | |
2016 | 75 (16.0) | 80 (17.1) | 0 | |
2017 | 88 (18.8) | 96 (20.5) | 0 | |
2018 | 98 (20.9) | 85 (18.2) | 0 | |
2019 | 90 (19.2) | 96 (20.5) | 0 | |
Age, years, median (IQR) | 63.00 [50.00, 71.00] | 64.00 [53.00, 72.00] | 0 | 0.123 |
Men, n (%) | 378 (80.8) | 393 (84.0) | 0 | 0.084 |
Witness status, n (%) | 378 (80.8) | 380 (81.2) | 0 | 0.011 |
Bystander CPR | 268 (57.3) | 261 (55.8) | 0 | 0.03 |
Adrenaline administration at pre-hospital, n (%) | 121 (25.9) | 134 (28.6) | 0 | 0.062 |
Tracheal intubation, n (%) | 215 (45.9) | 250 (53.4) | 0 | 0.15 |
First documented rhythm after hospital arrival | 0 | 0.051 | ||
shockable | 146 (31.2) | 161 (34.4) | 0 | |
non-shockable | 137 (29.3) | 127 (27.1) | 0 | |
presence of pulse | 185 (39.5) | 180 (38.5) | 0 | |
Time from call to hospital arrival, mins, median (IQR) | 29.00 [24.00, 36.00] | 30.00 [24.00, 37.00] | 0 | 0.051 |
Adrenaline administration at in-hospital, n (%) | 241 (51.5) | 247 (52.8) | 0 | 0.026 |
Coronary angiography, n (%) | 432 (92.3) | 437 (93.4) | 0 | 0.041 |
Target temperature management, n (%) | 238 (50.9) | 287 (61.3) | 0 | 0.212 |
Extracorporeal membrane oxygenation, n (%) | 173 (37.0) | 170 (36.3) | 0 | 0.013 |
Cardiac cause, n (%) | 456 (97.4) | 456 (97.4) | 0 | 0 |
Total | With IABP | Without IABP | Crude OR | (95% CI) | Crude OR (IPW) * | (95% CI) | ||||
---|---|---|---|---|---|---|---|---|---|---|
All patients | (N = 2738) | (N = 960) | (N = 1778) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 1049 | (38.1) | 288 | (30.0) | 761 | (42.8) | 0.57 | (0.48–0.68) | 1.18 | (0.91–1.53) |
One-month survival, n (%) | 1487 | (54.3) | 480 | (50.0) | 1007 | (56.6) | 0.77 | (0.65–0.90) | 1.19 | (0.92–1.53) |
Propensity score-matched patients | (N = 936) | (N = 468) | (N = 468) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 414 | (44.2) | 205 | (43.8) | 209 | (44.7) | 0.97 | (0.75–1.25) | N/A | |
One-month survival, n (%) | 586 | (62.6) | 290 | (62.0) | 296 | (63.3) | 0.95 | (0.73–1.23) | N/A |
Total | With IABP | Without IABP | Crude OR | (95% CI) | Adjusted * OR | (95% CI) | ||||
---|---|---|---|---|---|---|---|---|---|---|
Age group * | ||||||||||
18–64 years old | (N = 1308) | (N = 518) | (N = 790) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 628 | (48.0) | 178 | (34.4) | 450 | (57.0) | 0.40 | (0.31–0.50) | 1.24 | (0.85–1.80) |
One-month survival, n (%) | 799 | (61.1) | 272 | (52.5) | 527 | (66.7) | 0.55 | (0.44–0.69) | 1.33 | (0.93–1.91) |
≥65 years old | (N = 1430) | (N = 442) | (N = 988) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 421 | (29.4) | 110 | (24.9) | 311 | (31.5) | 0.72 | (0.56–0.93) | 0.88 | (0.59–1.31) |
One-month survival, n (%) | 688 | (48.1) | 208 | (47.1) | 480 | (48.6) | 0.94 | (0.75–1.18) | 1.01 | (0.69–1.51) |
Witness status ⁑ | ||||||||||
Witness | (N = 2164) | (N = 764) | (N = 1400) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 893 | (41.3) | 246 | (32.2) | 647 | (46.2) | 0.55 | (0.46–0.66) | 1.07 | (0.80–1.44) |
One-month survival, n (%) | 1221 | (56.4) | 390 | (51.1) | 831 | (59.4) | 0.71 | (0.60–0.85) | 1.14 | (0.85–1.54) |
Without witness | (N = 574) | (N = 196) | (N = 378) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 156 | (27.2) | 42 | (21.4) | 114 | (30.2) | 0.63 | (0.42–0.95) | 1.08 | (0.53–2.21) |
One-month survival, n (%) | 266 | (46.3) | 90 | (45.9) | 176 | (46.6) | 0.97 | (0.69–1.14) | 1.54 | (0.84–2.84) |
First documented rhythm after arrived hospital † | ||||||||||
Shockable thythm | (N = 856) | (N = 457) | (N = 399) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 260 | (30.4) | 135 | (29.5) | 125 | (31.3) | 0.92 | (0.69–1.23) | 1.45 | (0.93–2.28) |
One-month survival, n (%) | 397 | (46.4) | 217 | (47.5) | 180 | (45.1) | 1.10 | (0.84–1.44) | 1.28 | (0.85–1.92) |
Non-shockable rhythm | (N = 835) | (N = 292) | (N = 543) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 56 | (6.7) | 24 | (8.2) | 32 | (5.9) | 1.43 | (0.83–2.48) | 1.13 | (0.54–2.36) |
One-month survival, n (%) | 196 | (23.5) | 93 | (31.9) | 103 | (19.0) | 1.99 | (1.44–2.77) | 1.49 | (0.94–2.34) |
Presence of pulse | (N = 1047) | (N = 211) | (N = 836) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 733 | (70.0) | 129 | (61.1) | 604 | (72.3) | 0.60 | (0.44–0.83) | 0.78 | (0.50–1.21) |
One-month survival, n (%) | 894 | (85.4) | 170 | (80.6) | 724 | (86.6) | 0.65 | (5.30–7.89) | 0.79 | (0.43–1.44) |
Reperfusion therapy ‡ | ||||||||||
PCI | (N = 966) | (N = 590) | (N = 376) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 411 | (42.6) | 188 | (31.9) | 223 | (59.3) | 0.32 | (0.25–0.42) | 0.98 | (0.67–1.42) |
One-month survival, n (%) | 597 | (61.8) | 314 | (53.2) | 283 | (75.3) | 0.37 | (0.28–0.50) | 1.17 | (0.79–1.73) |
Non-PCI | (N = 1772) | (N = 370) | (N = 1402) | |||||||
CPC 1 or 2, one month after OHCA, n (%) | 638 | (36.0) | 100 | (27.0) | 538 | (38.4) | 0.59 | (0.46–0.77) | 1.03 | (0.69–1.52) |
One-month survival, n (%) | 890 | (50.2) | 166 | (44.9) | 724 | (51.6) | 0.76 | (0.61–0.96) | 1.10 | (0.76–1.57) |
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Yoshimura, S.; Kiguchi, T.; Irisawa, T.; Yamada, T.; Yoshiya, K.; Park, C.; Nishimura, T.; Ishibe, T.; Kobata, H.; Kishimoto, M.; et al. Intra-Aortic Balloon Pump among Shockable Out-of-Hospital Cardiac Arrest Patients: A Propensity-Weighted Analysis in a Multicenter, Nationwide Observational Study in Japan (The JAAM-OHCA Registry). J. Clin. Med. 2023, 12, 5945. https://doi.org/10.3390/jcm12185945
Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Kobata H, Kishimoto M, et al. Intra-Aortic Balloon Pump among Shockable Out-of-Hospital Cardiac Arrest Patients: A Propensity-Weighted Analysis in a Multicenter, Nationwide Observational Study in Japan (The JAAM-OHCA Registry). Journal of Clinical Medicine. 2023; 12(18):5945. https://doi.org/10.3390/jcm12185945
Chicago/Turabian StyleYoshimura, Satoshi, Takeyuki Kiguchi, Taro Irisawa, Tomoki Yamada, Kazuhisa Yoshiya, Changhwi Park, Tetsuro Nishimura, Takuya Ishibe, Hitoshi Kobata, Masafumi Kishimoto, and et al. 2023. "Intra-Aortic Balloon Pump among Shockable Out-of-Hospital Cardiac Arrest Patients: A Propensity-Weighted Analysis in a Multicenter, Nationwide Observational Study in Japan (The JAAM-OHCA Registry)" Journal of Clinical Medicine 12, no. 18: 5945. https://doi.org/10.3390/jcm12185945