Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest
| Autor: | Christopher M. Sciortino, Meshe Chonde, Penny L. Sappington, Anson J. Conrad Smith, Frank X Guyette, Mark Schmidhofer, Jeremiah Escajeda, Jonathan Elmer, Robert L. Kormos, Arthur J. Boujoukos, Clifton W. Callaway |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Emergency Medical Services medicine.medical_specialty Adolescent 030204 cardiovascular system & hematology Emergency Nursing Out of hospital cardiac arrest Young Adult 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Emergency medical services Humans Medicine Extracorporeal cardiopulmonary resuscitation High probability business.industry 030208 emergency & critical care medicine Shockable rhythm EMS dispatch Middle Aged Cardiopulmonary Resuscitation Checklist Emergency medicine Emergency Medicine Cardiology and Cardiovascular Medicine business Delivery of Health Care Out-of-Hospital Cardiac Arrest Healthcare system |
| Zdroj: | Resuscitation. 148:259-265 |
| ISSN: | 0300-9572 |
| Popis: | Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation. Aims The aim of our protocol was to demonstrate that an ECPR team was feasible within our healthcare system and that the identification of UPMC Presbyterian as a receiving center allowed for successful treatment within 30 min from EMS dispatch. Methods We developed out of hospital cardiac arrest (OHCA) ECPR protocols for Emergency Medical Services (EMS), EMS communications, and our in-hospital ECPR team. Inclusion criteria indentified patients with a potentially reversible arrest etiology and high probability of recoverable brain injury using a simple checklist: witnessed collapse, layperson CPR, initial shockable rhythm, and age 18–60 years. We trained local EMS crews to screen patients and reviewed the criteria with a Medic Command Physician prior to transport to our hospital. Results From October 2015 to March 31st 2018, EMS treated 1165 EMS OHCA cases, transported 664 (57%) to a local hospital, and transported 120 (10%) to our institution. Of these, five (4.1%) patients underwent ECPR. Among excluded cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. For ECPR cases, median pre-hospital CPR duration was 26 [IQR 25–40] min. Four patients (80%) received mechanical CPR. Interval from arrest to arrival on scene was 5 [IQR 4–6] min and interval from radio call to activation of ECPR was 13 [IQR 7–21] min. Interval from EMS dispatch to departure from scene was 20 [IQR 19–21] min. Time from EMS dispatch to initiation of ECPR was 63 [IQR 59–69] min. Conclusions ECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation. |
| Databáze: | OpenAIRE |
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