A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest.

Autor: Grunau B; St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada. Electronic address: Brian.Grunau@ubc.ca., Bashir J; St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada., Cheung A; St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada., Boone R; St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiology, University of British Columbia, Canada., McDonald K; St. Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada., Scheuermeyer F; St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada., Singer J; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada., Jenneson S; Department of Emergency Medicine, University of British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Royal Columbian Hospital, New Westminster, B.C., Canada., Straight R; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada., Twaites B; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada., Harris L; St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada., Haig S; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada., Harris D; Department of Emergency Medicine, University of British Columbia, Canada; Kelowna General Hospital, Kelowna, B.C., Canada., Vandegriend R; Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada., Kanji H; Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada; Vancouver General Hospital, Vancouver, B.C., Canada., Christenson J; St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2021 Oct; Vol. 167, pp. 22-28. Date of Electronic Publication: 2021 Aug 09.
DOI: 10.1016/j.resuscitation.2021.08.004
Abstrakt: Objectives: Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system.
Methods: We introduced a prehospital-activated ECPR protocol for select refractory OHCAs into one of four metropolitan regions in British Columbia. We prospectively identified ECPR-eligible patients in both the ECPR region and the three other regions to serve as the control group. We compared the proportion with favorable neurological outcomes at hospital discharge (cerebral performance category ≤2) and used logistic regression to estimate the association with treatment region.
Results: The study was terminated prematurely due to changes in hospital protocols and COVID-19. In the ECPR region, 15/58 (25.9%) patients had favourable neurological outcomes owing to conventional resuscitation and 2/58 (3.4%) owing to ECPR, for a total of 17/58 (29.3%). In the control regions, 67/250 (26.8%) patients had a favourable outcome owing to conventional resuscitation, for a between-group difference of 2.5% (95% CI -10 to 15%). We did not detect a statistically significant association between treatment region and outcomes.
Conclusion: In this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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