# Characteristics of patients requiring tracheostomy following extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

## TL;DR

This study examines patients who needed tracheostomies after ECPR for out-of-hospital cardiac arrest, finding that most had the procedure after ECMO weaning, with mixed survival and neurological outcomes.

## Contribution

The study provides real-world data on tracheostomy timing and outcomes following ECPR for OHCA.

## Key findings

- 14.5% of patients underwent tracheostomy, mostly after ECMO weaning.
- 81.2% of tracheostomy patients survived to discharge, but only 15.9% had favorable neurological outcomes.
- Early and late tracheostomy subgroups showed no significant differences in survival or neurological outcomes.

## Abstract

This study aimed to describe the characteristics of patients requiring tracheostomy following extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) using real-world data from a multicenter registry.

This was a secondary analysis of the SAVE-J II study, a retrospective multicenter registry study in Japan. Patients with OHCA aged ≥18 years who underwent ECPR between January 2013 and December 2018 were included. Participants were classified into the tracheostomy and non-tracheostomy groups, with the tracheostomy group further categorized into early (≤10 days) and late (>10 days) subgroups. Survival and favorable neurological outcome at hospital discharge were the primary outcomes.

Overall, this study included 1,910 patients with a median age of 61 (interquartile range [IQR], 49–69) years, of whom 1,610 (82.6%) were male. Of the participants, 276 (14.5%) underwent tracheostomy, with 224 (81.2%) and 44 (15.9%) surviving to discharge and achieving favorable neurological outcomes at hospital discharge, respectively. The median duration to tracheostomy was 10 (IQR, 8–14) days, with 98% of tracheostomies performed following extracorporeal membrane oxygenation (ECMO) weaning. The early tracheostomy group accounted for 145 patients (54.7%). The early and late tracheostomy subgroups showed no significant differences in survival or favorable neurological outcomes at discharge.

Following ECPR, 14.5% of the patients underwent tracheostomy, with the majority performed following ECMO weaning. Although the survival rate at discharge among these patients was 81.2%, only 15.9% exhibited favorable neurological outcomes. To explore the long-term outcomes of patients treated with ECPR for OHCA, future studies are needed.