The effectiveness of prophylactic antibiotics administration on the prevention of ventilator-associated pneumonia in out-of-hospital cardiac arrest patients undergoing ECPR
Abstract
Aim Despite improved outcomes with extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) patients, ventilator-associated pneumonia (VAP) remains a significant complication. While prophylactic antibiotics are not recommended for conventional CPR, their effectiveness in ECPR patients remains unclear. Methods This was a secondary analysis of the SAVE-J II study, a multicenter, retrospective cohort of OHCA patients treated with ECPR. Patients who died within three days of admission were excluded. The primary outcome was early-onset VAP development, with secondary outcomes being 30-day mortality and neurological outcomes at discharge. The effect of prophylactic antibiotics, administered within 24 h after admission, was estimated by combining propensity score matching and multivariable logistic regression. Missing covariates were multiply imputed. Results Of 2157 patients, 919 were included for propensity score matching, yielding a matched cohort of 448. In the matched cohort, prophylactic antibiotics administration was not significantly associated with VAP incidence (aOR, 0.62; 95% CI, 0.39–1.01), although the incidence was numerically lower (24.1% vs 31.3%). No effects were observed in 30-day mortality (aOR, 1.00; 95% CI, 0.64–1.57) or unfavorable neurological outcomes (aOR, 0.92; 95% CI, 0.56–1.52). Sensitivity analyses using different definitions of VAP and population yielded consistent results. Conclusions Although point estimates…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 2,157 participants or records.
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