Abstract 4146277: Risk and Predictors of Hemorrhagic Complications in Extracorporeal Cardiopulmonary Resuscitation Patients: Insights from the SAVE-J 2 Registry

Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) is an emerging resuscitative therapy for patients with refractory cardiac arrests with various underlying conditions. However, hemorrhagic complications remain a significant challenge, adversely affecting patient outcomes. Research Questions: Risks and predictors of hemorrhagic complications in E-CPR patients may differ based on the causes of cardiac arrest. Aims: To compare the risks and predictors of hemorrhagic complications among the groups with different causes of cardiac arrest in patients undergoing E-CPR. Methods: The SAVE-J 2 registry is a multicenter registry of patients who underwent E-CPR for out-of-hospital cardiac arrest (OHCA) from 2013 to 2018. The patients were stratified into three groups based on the underlying causes of OHCA: endogenous cardiac, endogenous non-cardiac, and exogenous. The primary outcome was any bleeding, whereas the secondary outcomes included bleeding at cannulation sites and non-cannulation site bleeding. Pre-specified covariates were evaluated using the Cox proportional hazards model to identify the independent risk factors for bleeding. Results: Of the 2,070 patients who underwent E-CPR, 1,498 had endogenous cardiac causes, 344 had endogenous non-cardiac causes, and 228 had exogenous causes. The median follow-up among survivors was 35 days (interquartile range [IQR]: 21-55 days). Most of the bleeding events occurred within a week after E-CPR (median two days, [IQR: 1-8 days]). The 30-day cumulative incidence of any bleeding was significantly different among the three groups (endogenous-cardiac: 342 [26.1%]; endogenous-noncardiac: 47 [18.9%] and exogenous: 31 [15.1%], P<0.001). There was also significant difference among the three groups regarding puncture-related bleeding and non-puncture site bleeding (Figure). Multivariable analysis suggested that the potential risk-estimating variables for bleeding were different among the three groups. Conclusions: Hemorrhagic complication risks and predictors vary depending on causes of cardiac arrest in E-CPR patients. These findings highlight the need for individualized management strategies to mitigate bleeding risks and improve outcomes.