A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest
| Autor: | Ken McDonald, Richard A. Vandegriend, Sandra Jenneson, Frank X. Scheuermeyer, Brian Twaites, Brian Grunau, Scott Haig, Jim Christenson, Joel Singer, Robert H. Boone, Hussein D. Kanji, Luke Harris, Ron Straight, Devin Harris, Anson Cheung, Jamil Bashir |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
2019-20 coronavirus outbreak
medicine.medical_specialty Resuscitation Emergency Medical Services Coronavirus disease 2019 (COVID-19) business.industry SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) medicine.medical_treatment COVID-19 Emergency Nursing Out of hospital cardiac arrest Cardiopulmonary Resuscitation Refractory Emergency medicine Emergency Medicine Extracorporeal membrane oxygenation Hospital discharge Medicine Humans Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest Randomized Controlled Trials as Topic |
| Zdroj: | Resuscitation. 167 |
| ISSN: | 1873-1570 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect