The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes.

Autor:	Bartos JA; Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States., Frascone RJ; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States.; Department of Emergency Medicine, Regions Hospital, St. Paul, MN, United States., Conterato M; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States.; Department of Emergency Medicine, and North Memorial EMS, North Memorial Medical Center, Robbinsdale, MN, United States., Wesley K; M Health Fairview Emergency Medical Services, MN, United States., Lick C; Allina Health Emergency Medicinal Services, MN, United States., Sipprell K; Ridgeview Emergency Medicinal Services, MN, United States., Vuljaj N; M Health Fairview Emergency Medical Services, MN, United States., Burnett A; Woodbury and Cottage Grove, Emergency Medical Services, MN, United States., Peterson BK; Lakeview and Maplewood Emergency Medical Services, United States., Simpson N; Hennepin County Emergency Medical Services, Hennepin County, Minneapolis Minnesota, United States., Ham K; Regions Hospital, Health Partners, St Paul Minnesota, United States., Bruen C; Regions Hospital, Health Partners, St Paul Minnesota, United States., Woster C; Regions Hospital, Health Partners, St Paul Minnesota, United States., Haley KB; Regions Hospital, Health Partners, St Paul Minnesota, United States., Moore J; Hennepin County Emergency Medical Services, Hennepin County, Minneapolis Minnesota, United States., Trigger B; M Heath Fairview Southdale Hospital Emergency Medicine Department, United States., Hodgson L; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States., Harkins K; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States., Kosmopoulos M; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States., Aufderheide TP; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee WI, United States., Tolar J; Dean of the Medical School and Vice President of Clinical affairs at the University of Minnesota, Minneapolis, MN, United States., Yannopoulos D; Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2020 Nov 13; Vol. 29-30, pp. 100632. Date of Electronic Publication: 2020 Nov 13 (Print Publication: 2020).
DOI:	10.1016/j.eclinm.2020.100632
Abstrakt:	Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). Methods: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit. Findings: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31-56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2. Interpretation: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities. Funding: The Helmsley Charitable Trust. Competing Interests: All authors report having received funding from the Leona M. and Harry B. Helmsley Charitable Trust. JAB, TPA, and DY also received funding from the National Heart, Lung, and Blood Institute. (© 2020 The Authors.)
Databáze:	MEDLINE
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