Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol

Abstract

Aim: To compare the outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA) fulfilling the criteria for extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an ECPR protocol, whether the patient received ECPR or not. Methods:We compared cardiac arrest registry data before (2014À2015) and after (2016À2019) implementation of the ECPR protocol. The ECPR criteria were presumed cardiac origin, witnessed arrest with ventricular fibrillation, bystander CPR, age 18À65, advanced life support (ALS) within 15 min and ALS > 10 min without return of spontaneous circulation (ROSC). The primary outcome was 30-day survival; the secondary outcomes were sustained ROSC, neurological outcome and the proportion of patients transported with ongoing ALS.Results: There were 1086 and 3135 patients in the pre-and post-implementation sample; 48 (4%) and 100 (3%) met the ECPR criteria, respectively. Of these, 21 (44%) vs. 37 (37%) were alive after 30 days, p = 0.4, and 30 (63%) vs. 50 (50%) achieved sustained ROSC, p = 0.2. All survivors in the preimplementation sample had cerebral performance category 1À2 vs. 30 (81%) in the post-implementation sample, p = 0.03. Of the patients fulfilling the ECPR criteria, 7 (15%) and 26 (26%), p = 0.1, were transported with ongoing ALS in the pre-and post-implementation sample, respectively.Conclusions: There were no differences in 30-day survival or prehospital ROSC in patients with refractory OHCA before and after initiation of an ECPR protocol.

Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial

“…Further, almost all randomized patients in both prospective ECPR studies [ 7 , 8 ] had witnessed arrest with high rate of bystander CPR which is another important prerequisite for good outcomes. Moreover, only 6% of all OHCA patients were enrolled in the Prague OHCA trial which is in line with previous reports [ 21 , 22 ]. This confirms that ECPR is not a substitute for conventional ACLS but rather complementary method for properly selected refractory OHCA patients provided in the well-organized system [ 7 , 8 ].…”

Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest

“…During the study period, randomized patients constituted 6% of all persons who experienced cardiac arrest and received CPR (Figure 1). This is comparable to the proportions in Vienna and other studies that have suggested 4% to 6% of OHCAs to be suitable for an intra-arrest transport approach . However, in these studies, potential candidates were evaluated retrospectively, whereas in this study, patients were evaluated during ongoing on-scene CPR.…”

In-hospital extracorporeal cardiopulmonary resuscitation for patients with an out-of-hospital cardiac arrest in a semi-rural setting: An observational study on the implementation of a helicopter emergency medical services pathway

“…This may explain the low number of potential eligible candidates (1.2%), compared to other studies. 7 …”

“…Several studies have demonstrated positive results of ECPR on neurologically intact survival, 4 , 5 , 6 but more recent registry studies could not demonstrate a beneficial effect on outcome. 7 , 8 Moreover, ECPR has a significant risk of complications (leg ischaemia, bleeding from the insertion site, infection and intracranial haemorrhage), and comes with significant cost and logistical challenges. Therefore, ECPR is only offered as a treatment to patients most likely to benefit and have a positive outcome.…”