Prophylactic Antibiotics and 30-Day Survival in Out-Of-Hospital Cardiac Arrest Patients Undergoing VA-ECMO: A Multicenter Observational Study.

BACKGROUND: Patients with out-of-hospital cardiac arrest (OHCA) undergoing extracorporeal cardiopulmonary resuscitation with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are at high risk of nosocomial infections, and prophylactic antibiotics may reduce the infections, but there is limited evidence. This study evaluated the effectiveness of prophylactic antibiotic administration on survival and neurological outcomes in patients with OHCA receiving VA-ECMO. METHODS: As a prespecified research question within the Survey of Survivors after Cardiac Arrest in the Kanto Area in 2017 (SOS-KANTO 2017) study, we conducted a multicenter observational study analyzing 153 patients with OHCA who underwent VA-ECMO between September 2019 and March 2021. Patients were categorized into the prophylactic antibiotic group (n = 106) or control group (n = 47). The primary endpoint was 30-day survival, and the secondary endpoints were ECMO-free days and a 30-day cerebral performance category of 1 or 2. RESULTS: After Inverse Probability of Treatment Weighting (IPTW), the 30-day survival was significantly higher in the antibiotic group than in the control group (42.8% vs. 20.3%; p < 0.001) and also ECMO-free days were higher in the antibiotic group (7.1 days vs. 1.4 days; p < 0.001). However, there was no significant difference in neurological outcomes (13.2% vs. 11.1%; p = 0.584). CONCLUSIONS: Prophylactic antibiotic administration during VA-ECMO was associated with improved 30-day survival in patients with OHCA. Although these findings suggest a potential benefit, further randomized controlled trials are required to establish clinical recommendations.