Lionel Lamhaut1, Alice Hutin2, Etienne Puymirat3, Jérome Jouan4, Jean-Herlé Raphalen5, Romain Jouffroy5, Murielle Jaffry6, Christelle Dagron5, Kim An5, Florence Dumas7, Eloi Marijon8, Wulfran Bougouin9, Jean-Pierre Tourtier10, Frédéric Baud5, Xavier Jouven8, Nicolas Danchin3, Christian Spaulding8, Pierre Carli11. 1. SAMU de Paris and intensive care unit, Necker Hospital, Assistance Publique-Hopitaux de Paris (APHP), 149 rue de de Sevres 75015 Paris, France; Paris Sudden Death Expertise Center, Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France. Electronic address: lionel@lamhaut.fr. 2. SAMU de Paris and intensive care unit, Necker Hospital, Assistance Publique-Hopitaux de Paris (APHP), 149 rue de de Sevres 75015 Paris, France; Inserm, U955, Equipe 03, F94000 Créteil, France. 3. Cardiology Department, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris (APHP), 20-40 rue Leblanc, 75908 Paris Cedex 15, France; Universite, Paris Descartes-Sorbonne Paris Cite, Paris, France. 4. Cardio-surgery Department, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris (APHP), 20-40 rue Leblanc, 75908 Paris Cedex 15, France. 5. SAMU de Paris and intensive care unit, Necker Hospital, Assistance Publique-Hopitaux de Paris (APHP), 149 rue de de Sevres 75015 Paris, France. 6. SAMU 97-1, CHU Pointe à Pitre/Abymes, route de Chauvel, 97159 Pointe à Pitre cedex, Guadeloupe, France. 7. Paris Sudden Death Expertise Center, Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Universite, Paris Descartes-Sorbonne Paris Cite, Paris, France; Emergency departement, Cochin hospital, Assistance Publique-Hopitaux de Paris (APHP) Paris France. 8. Paris Sudden Death Expertise Center, Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France; Cardiology Department, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris (APHP), 20-40 rue Leblanc, 75908 Paris Cedex 15, France; Universite, Paris Descartes-Sorbonne Paris Cite, Paris, France. 9. Inserm, U955, Equipe 03, F94000 Créteil, France; Cardiology Department, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris (APHP), 20-40 rue Leblanc, 75908 Paris Cedex 15, France. 10. Brigade des Sapeurs-Pompiers de Paris, Paris, France. 11. SAMU de Paris and intensive care unit, Necker Hospital, Assistance Publique-Hopitaux de Paris (APHP), 149 rue de de Sevres 75015 Paris, France; Universite, Paris Descartes-Sorbonne Paris Cite, Paris, France.
Abstract
BACKGROUND: Out of hospital cardiac arrest (OHCA) mortality rates remain very high with poor neurological outcome in survivors. Extracorporeal cardiopulmonary resuscitation (ECPR) is one of the treatments of refractory OHCA. This study used data from the mobile intensive care unit (MOICU) as part of the emergency medical system of Paris, and included all consecutive patients treated with ECPR (including pre-hospital ECPR) from 2011 to 2015 for the treatment of refractory OHCA, comparing two historical ECPR management strategies. METHODS: We consecutively included refractory OHCA patients. In Period 1, ECPR was indicated in selected patients after 30min of advanced life support; in- or pre-hospital implementation depended on estimated transportation time and ECPR team availability. In Period 2, patient care relied on early ECPR initiation after 20min of resuscitation, stringent patient selection, epinephrine dose limitation and deployment of ECPR team with initial response team. Primary outcome was survival with good neurological function Cerebral Performance Category score (CPC score) 1 and 2 at ICU discharge or day 28. FINDINGS: A total of 156 patients were included. (114 in Period 1 and 42 in Period 2). Baseline characteristics were similar. Mean low-flow duration was shorter by 20min (p<0.001) in Period 2. Survival was significantly higher in Period 2: 29% vs 8% (P<0.001), as confirmed by the multivariate analysis and propensity score. When combining stringent patient selection with an aggressive strategy, the survival rate increased to 38%. Pre-hospital ECPR implementation in itself was not an independent predictor of improved survival, but it was part of the strategy in Period 2. INTERPRETATION: Our data suggest that ECPR in specific settings in the management of refractory OHCA is feasible and can lead to a significant increase in neurological intact survivors. These data, however, need to be confirmed by a large RCT.
BACKGROUND: Out of hospital cardiac arrest (OHCA) mortality rates remain very high with poor neurological outcome in survivors. Extracorporeal cardiopulmonary resuscitation (ECPR) is one of the treatments of refractory OHCA. This study used data from the mobile intensive care unit (MOICU) as part of the emergency medical system of Paris, and included all consecutive patients treated with ECPR (including pre-hospital ECPR) from 2011 to 2015 for the treatment of refractory OHCA, comparing two historical ECPR management strategies. METHODS: We consecutively included refractory OHCA patients. In Period 1, ECPR was indicated in selected patients after 30min of advanced life support; in- or pre-hospital implementation depended on estimated transportation time and ECPR team availability. In Period 2, patient care relied on early ECPR initiation after 20min of resuscitation, stringent patient selection, epinephrine dose limitation and deployment of ECPR team with initial response team. Primary outcome was survival with good neurological function Cerebral Performance Category score (CPC score) 1 and 2 at ICU discharge or day 28. FINDINGS: A total of 156 patients were included. (114 in Period 1 and 42 in Period 2). Baseline characteristics were similar. Mean low-flow duration was shorter by 20min (p<0.001) in Period 2. Survival was significantly higher in Period 2: 29% vs 8% (P<0.001), as confirmed by the multivariate analysis and propensity score. When combining stringent patient selection with an aggressive strategy, the survival rate increased to 38%. Pre-hospital ECPR implementation in itself was not an independent predictor of improved survival, but it was part of the strategy in Period 2. INTERPRETATION: Our data suggest that ECPR in specific settings in the management of refractory OHCA is feasible and can lead to a significant increase in neurological intact survivors. These data, however, need to be confirmed by a large RCT.
Authors: Morgann Loaec; Adam S Himebauch; Todd J Kilbaugh; Robert A Berg; Kathryn Graham; Richard Hanna; Heather A Wolfe; Robert M Sutton; Ryan W Morgan Journal: Resuscitation Date: 2020-05-15 Impact factor: 5.262
Authors: Piotr Mazur; Sylweriusz Kosiński; Paweł Podsiadło; Anna Jarosz; Roman Przybylski; Radosław Litiwnowicz; Jacek Piątek; Janusz Konstanty-Kalandyk; Robert Gałązkowski; Tomasz Darocha Journal: Ann Cardiothorac Surg Date: 2019-01
Authors: Brian Grunau; Noah Kime; Brian Leroux; Thomas Rea; Gerald Van Belle; James J Menegazzi; Peter J Kudenchuk; Christian Vaillancourt; Laurie J Morrison; Jonathan Elmer; Dana M Zive; Nancy M Le; Michael Austin; Neal J Richmond; Heather Herren; Jim Christenson Journal: JAMA Date: 2020-09-15 Impact factor: 56.272
Authors: Darryl Abrams; A Reshad Garan; Akram Abdelbary; Matthew Bacchetta; Robert H Bartlett; James Beck; Jan Belohlavek; Yih-Sharng Chen; Eddy Fan; Niall D Ferguson; Jo-Anne Fowles; John Fraser; Michelle Gong; Ibrahim F Hassan; Carol Hodgson; Xiaotong Hou; Katarzyna Hryniewicz; Shingo Ichiba; William A Jakobleff; Roberto Lorusso; Graeme MacLaren; Shay McGuinness; Thomas Mueller; Pauline K Park; Giles Peek; Vin Pellegrino; Susanna Price; Erika B Rosenzweig; Tetsuya Sakamoto; Leonardo Salazar; Matthieu Schmidt; Arthur S Slutsky; Christian Spaulding; Hiroo Takayama; Koji Takeda; Alain Vuylsteke; Alain Combes; Daniel Brodie Journal: Intensive Care Med Date: 2018-02-15 Impact factor: 17.440
Authors: Tom P Aufderheide; Rajat Kalra; Marinos Kosmopoulos; Jason A Bartos; Demetris Yannopoulos Journal: Ann N Y Acad Sci Date: 2021-02-20 Impact factor: 5.691