Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low‐Flow Duration: Insights From a Nationwide Hospital‐Based Registry Study in Japan (JAAM‐OHCA Registry)
Bibliographic record
Abstract
Background The optimal low‐flow duration (LFD) for extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) remains unclear. We evaluated the impact of LFD on neurological outcomes based on initial cardiac rhythms and compared trends between ECPR and CCPR. Methods This secondary analysis used data from a nationwide, prospective study of adult (≥18 years) nontraumatic patients with out‐of‐hospital cardiac arrest receiving cardiopulmonary resuscitation upon hospital arrival (June 2014–December 2019). LFD was defined as time from professional cardiopulmonary resuscitation initiation to ECPR initiation or return of spontaneous circulation/termination of resuscitation in CCPR. The primary outcome was 1‐month survival with favorable neurological status (Cerebral Performance Category scale 1 or 2). Patients were stratified into 4 groups based on first documented cardiac rhythm (pre‐ or in‐hospital). Results Among 42 365 patients (1355 ECPR, 36 991 CCPR), longer LFD was associated with poorer neurological outcomes in patients with initial shockable rhythms, regardless of ECPR or CCPR use. The highest favorable outcome rates were observed in the Shockable–Shockable groups (ECPR: 16.0%; CCPR: 16.9%), with a clear decline in outcomes as LFD increased (both P for trend <0.001). In contrast, this trend was absent in ECPR‐treated patients with initial nonshockable rhythms, who had consistently poor outcomes. Conclusions Longer LFD is associated with worse outcomes in patients with initial shockable rhythms. This association was not observed in nonshockable cases, although their prognosis was generally poor. Defining rhythm‐specific LFD thresholds may guide ECPR use and improve outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".