Tahar Chouihed1,2,3, Antoine Kimmoun4,2,5,6, Adrien Lauvray1, Francois-Xavier Laithier4, Deborah Jaeger1, Simon Lemoine5, Juan Pablo Maureira5, Lionel Nace1, Kevin Duarte3,5,6, Stéphane Albizzati7, Nicolas Girerd2,3,5,6, Bruno Levy4,2,5,6. 1. SAMU-SMUR-SAU Nancy, Hôpital Central, CHRU Nancy, France. 2. Groupe choc, INSERM U1116, Faculté de Médecine, 54500 Vandoeuvre les Nancy, France. 3. INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy, France. 4. Service de Réanimation Médicale Brabois et pôle cardio-médico-chirurgical, CHRU Brabois 54500 Vandoeuvre les Nancy, France. 5. CHRU Nancy, Pôle de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy, France. 6. Université de Lorraine F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. 7. Service d'Urgence, Hôpital Saint Charles, Saint-Dié-Des-Vosges, France.
Abstract
BACKGROUND: Despite recent management improvement, including Extracorporeal Life Support (ECLS), refractory out of hospital cardiac arrest (ROHCA) survival remains dramatically low. METHODS: We assessed an innovative strategy (Out of hoSpital Cardiac ARrest-ExtraCorporeal Life Support-"OSCAR-ECLS") to optimize access to ECLS of ROHCA patients and reduce the delay between recognition and ECLS implantation. METHODS: This study, conducted in a tertiary teaching hospital, compared the survival and delay times of ROHCA patients treated by ECLS before and after OSCAR-ECLS implementation. This procedure included an early recognition of ROHCA 10 min after initiation of advanced cardiopulmonary resuscitation; the optimization of patient selection and reduction in time from collapse to ECLS initiation. RESULTS: Fourteen patients before and 32 patients after OSCAR-ECLS implementation were identified between 2013 and 2016. Time to ECLS initiation was 99 (90-107) min before OSCAR-ECLS vs. 80 (65-94) min during the OSCAR-ECLS period (P = 0.0007), mostly due to a reduction in time spent on site: 48 (40.0-54.0) min vs. 24 (20.0-28.0) min (P = 0.0001). Survival at hospital discharge was 7% (1/14) before OSCAR-ECLS and 25% (8/32) during the OSCAR-ECLS period (P = 0.20). Only one patient survived with a Glasgow Pittsburgh Cerebral Performance Category (CPC) score = 1 before the OSCAR-ECLS procedure while during the OSCAR-ECLS procedure, eight patients (25%) survived, six with a CPC score = 1, one with a CPC score = 2, and one with a CPC score = 3. CONCLUSIONS: The use of a new paradigm of ROHCA dramatically shortened the time to ECLS initiation by reducing the time spent on site by more than 20 min. Survival improved from 7% to 25% after implementation of OSCAR-ECLS.
BACKGROUND: Despite recent management improvement, including Extracorporeal Life Support (ECLS), refractory out of hospital cardiac arrest (ROHCA) survival remains dramatically low. METHODS: We assessed an innovative strategy (Out of hoSpital Cardiac ARrest-ExtraCorporeal Life Support-"OSCAR-ECLS") to optimize access to ECLS of ROHCApatients and reduce the delay between recognition and ECLS implantation. METHODS: This study, conducted in a tertiary teaching hospital, compared the survival and delay times of ROHCApatients treated by ECLS before and after OSCAR-ECLS implementation. This procedure included an early recognition of ROHCA 10 min after initiation of advanced cardiopulmonary resuscitation; the optimization of patient selection and reduction in time from collapse to ECLS initiation. RESULTS: Fourteen patients before and 32 patients after OSCAR-ECLS implementation were identified between 2013 and 2016. Time to ECLS initiation was 99 (90-107) min before OSCAR-ECLS vs. 80 (65-94) min during the OSCAR-ECLS period (P = 0.0007), mostly due to a reduction in time spent on site: 48 (40.0-54.0) min vs. 24 (20.0-28.0) min (P = 0.0001). Survival at hospital discharge was 7% (1/14) before OSCAR-ECLS and 25% (8/32) during the OSCAR-ECLS period (P = 0.20). Only one patient survived with a Glasgow Pittsburgh Cerebral Performance Category (CPC) score = 1 before the OSCAR-ECLS procedure while during the OSCAR-ECLS procedure, eight patients (25%) survived, six with a CPC score = 1, one with a CPC score = 2, and one with a CPC score = 3. CONCLUSIONS: The use of a new paradigm of ROHCA dramatically shortened the time to ECLS initiation by reducing the time spent on site by more than 20 min. Survival improved from 7% to 25% after implementation of OSCAR-ECLS.
Authors: Benjamin Pequignot; Mickael Lescroart; Sophie Orlowski; Nathan Reynette; Bana Martini; Eliane Albuisson; Héloise Pina; N'Guyen Tran; Daniel Grandmougin; Bruno Levy Journal: J Clin Med Date: 2022-04-29 Impact factor: 4.964
Authors: Emanuel M Dogan; Linus Beskow; Fredrik Calais; Tal M Hörer; Birger Axelsson; Kristofer F Nilsson Journal: Shock Date: 2019-07 Impact factor: 3.454