Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol.

Autor: Alm-Kruse K; 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., Sørensen G; Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital and University of Oslo, Oslo, Norway., Osbakk SA; Division of Prehospital Services, Oslo University Hospital and University of Oslo, Oslo, Norway., Sunde K; 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., Bendz B; 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., Andersen GØ; Department of Cardiology, Oslo University Hospital, Oslo, Norway., Fiane A; 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., Hagen OA; Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital and University of Oslo, Oslo, Norway., Kramer-Johansen J; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Division of Prehospital Services, Oslo University Hospital and University of Oslo, Oslo, Norway.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2021 May; Vol. 162, pp. 35-42. Date of Electronic Publication: 2021 Feb 10.
DOI: 10.1016/j.resuscitation.2021.01.038
Abstrakt: 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.
(Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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