How Feasible is Extracorporeal Cardiopulmonary Resuscitation in a Medium Urban Population Centre?

Autor:	Rollo D; Family Medicine, Saint John Regional Hospital, Saint John, CAN., Atkinson P; Emergency Medicine, Saint John Regional Hospital, Saint John, CAN., Mekwan J; Emergency Medicine, Horizon Health Network, Saint John, CAN., Lutchmedial S; Cardiology, New Brunswick Heart Centre, Saint John Regional Hospital / Dalhousie University, Saint John, CAN., Middleton J; Emergency Medicine, Saint John Regional Hospital, Saint John, CAN., French J; Emergency Medicine, Saint John Regional Hospital, Saint John, CAN., Chanyi S; Cardiac/Thoracic/Vascular Surgery, Saint John Regional Hospital, Saint John, CAN., Gould J; Emergency Medicine, Queen Elizabeth II Health Science Center / Dalhousie University, Halifax, CAN., Kovacs G; Emergency Medicine, Dalhousie University, Halifax, CAN., Légaré JF; Cardiac Surgery, Saint John Regional Hospital / Dalhousie University, Saint John, CAN., Tutschka M; Critical Care Medicine, Saint John Regional Hospital / Dalhousie University, Saint John, CAN., Fraser J; Emergency Medicine, Saint John Regional Hospital, Saint John, CAN., Howlett M; Emergency Medicine, Saint John Regional Hospital, Saint John, CAN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2019 Dec 08; Vol. 11 (12), pp. e6324. Date of Electronic Publication: 2019 Dec 08.
DOI:	10.7759/cureus.6324
Abstrakt:	Background Patients suffering from out-of-hospital cardiac arrest (OHCA) experience poor survival and neurological outcomes, with rates remaining relatively unchanged despite advancements. Extracorporeal membrane oxygenation (ECMO), termed extracorporeal cardiopulmonary resuscitation (ECPR) in arrests, may offer improved outcomes. We developed local screening criteria for ECPR and then estimated the frequency of use by applying those criteria retrospectively to a cardiac arrest database. The purpose was to determine if an ECPR program is feasible in a medium urban population centre in Atlantic Canada. Methods A three-round modified Delphi survey, building upon data from a literature review, was conducted in collaboration with external experts. The resulting selection criteria for potential ECPR candidates were applied to a pre-existing local cardiac arrest database, supplemented by health records review, identifying potential candidates eligible for ECPR. Results Consensus inclusion criteria included witnessed cardiac arrest, age <70, refractory arrest, no-flow time <10min, total downtime <60min, and presumed cardiac or selected non-cardiac etiologies. Consensus exclusion criteria were an unwitnessed arrest, asystole, and select etiologies and comorbidities. Simplified criteria were developed to facilitate emergency medical services transport. Historically, 20.0% (95% CI 16.2-24.3%) of OHCA would be transported to the Emergency Department (ED), with 4.9% (95% CI 3.0% to 7.6%) qualifying for ECPR. Conclusion Despite conservative estimates based upon historically small numbers of select cardiac arrest patients meeting eligibility for transport and initiation of ECPR, a dedicated program may be feasible in our regional hospital setting. Patient care volumes suggest it would not be resource intensive yet would be sufficiently busy to maintain competency. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2019, Rollo et al.)
Databáze:	MEDLINE
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