Abstract Sun303: Impact of COVID-19 pandemic for out-of-hospital cardiac arrest patients who received extracorporeal pulmonary resuscitation in Japan

Background: The influence of COVID-19 for out-of-hospital cardiac arrest (OHCA) who received extracorporeal pulmonary resuscitation (ECPR) was not fully elucidated. We examined whether there were differences in frequency and outcomes for OHCA patients who received ECPR during COVID-19 pandemic. Methods: Using the JAAM-OHCA registry, which is a nationwide registry, we evaluated the OHCA patients who received ECPR from 2019-2022. Since the first state of emergency was declared in April, 2020, we compared outcomes for OHCA patient before COVID-19 pandemic (from January 1, 2019 to March 31, 2020), and those during COVID-19 pandemic (from April 1, 2020 to December 31, 2022). We performed logistic regression analysis adjusted age, sex, witnessed cardiac arrest (CA), bystander cardiopulmonary resuscitation, initial/on hospital arrival shockable rhythm, and time from call to extracorporeal membrane oxygenation initiation and interrupted time series analysis (ITSA). Primary outcome was the proportion of 30-day neurological favorable outcome defined as Cerebral Performance Category scores of 1-2 between two groups. Results: After excluding patients, 1,903 ECPR cases (681 in pre-pandemic group and 1,222 in pandemic group) were included in the study period. ECPR frequency was decreased during pandemic (4.4% [681/15,344], 45.4 cases per month in pre-pandemic group, and 3.8% [1,222/32,020], 37.1 cases per month in pandemic group, OR 0.86 95%CI 0.78–0.94,p<0.01). Multivariable logistic regression analysis revealed COVID-19 pandemic was not associated with 30-day favorable neurological outcome (12.5% [85/681] in pre-pandemic group and 12.6% [154/1,221] in pandemic group, OR 0.92, 95%CI 0.67–1.30, p=0.64). ITSA revealed the frequency of ECPR decreased significantly (-17.2 per month, 95%CI -26.0–-8.5, p<0.01), while the proportion of 30-day neurological favorable outcomes did not differ (RR 1.16, 95%CI 0.70–1.96, p=0.56) during pandemic period. Conclusions: Although the frequency of ECPR for OHCA patients decreased, prognosis including favorable neurological outcomes did not differ during COVID-19 pandemic.