Kristin Alm-Kruse1, Gro Sørensen2, Svein Are Osbakk3, Kjetil Sunde4, Bjørn Bendz5, Geir Øystein Andersen6, Arnt Fiane5, Ove Andreas Hagen2, Jo Kramer-Johansen7. 1. Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: Kellings@ous-hf.no. 2. Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital and University of Oslo, Oslo, Norway. 3. Division of Prehospital Services, Oslo University Hospital and University of Oslo, Oslo, Norway. 4. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital and University of Oslo, Oslo, Norway. 5. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital and University of Oslo, Oslo, Norway. 6. Department of Cardiology, Oslo University Hospital, Oslo, Norway. 7. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Division of Prehospital Services, Oslo University Hospital and University of Oslo, Oslo, Norway.
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 (2014-2015) and after (2016-2019) implementation of the ECPR protocol. The ECPR criteria were presumed cardiac origin, witnessed arrest with ventricular fibrillation, bystander CPR, age 18-65, 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 pre-implementation sample had cerebral performance category 1-2 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.
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 (2014-2015) and after (2016-2019) implementation of the ECPR protocol. The ECPR criteria were presumed cardiac origin, witnessed arrest with ventricular fibrillation, bystander CPR, age 18-65, 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 pre-implementation sample had cerebral performance category 1-2 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.
Authors: Jan Belohlavek; Jana Smalcova; Daniel Rob; Ondrej Franek; Ondrej Smid; Milana Pokorna; Jan Horák; Vratislav Mrazek; Tomas Kovarnik; David Zemanek; Ales Kral; Stepan Havranek; Petra Kavalkova; Lucie Kompelentova; Helena Tomková; Alan Mejstrik; Jaroslav Valasek; David Peran; Jaroslav Pekara; Jan Rulisek; Martin Balik; Michal Huptych; Jiri Jarkovsky; Jan Malik; Anna Valerianova; Frantisek Mlejnsky; Petr Kolouch; Petra Havrankova; Dan Romportl; Arnost Komarek; Ales Linhart Journal: JAMA Date: 2022-02-22 Impact factor: 157.335