Elsevier

Resuscitation

Volume 189, August 2023, 109825
Resuscitation

Clinical paper
What is the potential benefit of pre-hospital extracorporeal cardiopulmonary resuscitation for patients with an out-of-hospital cardiac arrest? A predictive modelling study

https://doi.org/10.1016/j.resuscitation.2023.109825Get rights and content
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Abstract

Aim

In this predictive modelling study we aimed to investigate how many patients with an out-of-hospital cardiac arrest (OHCA) would benefit from pre-hospital as opposed to in-hospital initiation of extracorporeal cardiopulmonary resuscitation (ECPR).

Methods

A temporal spatial analysis of Utstein data was performed for all adult patients with a non-traumatic OHCA attended by three emergency medical services (EMS) covering the north of the Netherlands during a one-year period. Patients were considered potentially eligible for ECPR if they had a witnessed arrest with immediate bystander CPR, an initial shockable rhythm (or signs of life during resuscitation) and could be presented in an ECPR-centre within 45 minutes of the arrest. Endpoint of interest was defined as the hypothetical number of ECPR eligible patients after 10, 15 and 20 minutes of conventional CPR and upon (hypothetical) arrival in an ECPR-centre as a fraction of the total number of OHCA patients attended by EMS.

Results

During the study period 622 OHCA patients were attended, of which 200 (32%) met ECPR eligibility criteria upon EMS arrival. The optimal transition point between conventional CPR and ECPR was found to be after 15 minutes. Hypothetical intra-arrest transport of all patients in whom no return of spontaneous circulation (ROSC) was obtained after that point (n = 84) would have yielded 16/622 (2.5%) patients being potentially ECPR eligible upon hospital arrival (average low-flow time 52 minutes), whereas on-scene initiation of ECPR would have resulted in 84/622 (13.5%) potential candidates (average estimated low-flow time 24 minutes before cannulation).

Conclusion

Even in healthcare systems with relatively short transport distances to hospital, consideration should be given to pre-hospital initiation of ECPR for OHCA as it shortens low-flow time and increases the number of potentially eligible patients.

Keywords

Out-of-hospital cardiac arrest (OHCA)
Extracorporeal cardiopulmonary resuscitation (ECPR)
Pre-hospital

Abbreviations

ECPR
extracorporeal cardiopulmonary resuscitation
OHCA
out-of-hospital cardiac arrest
cCPR
conventional cardiopulmonary resuscitation
EMS
emergency medical service
ROSC
return of spontaneous circulation
VA-ECMO
veno-arterial extracorporeal membrane oxygenation
CPR
cardiopulmonary resuscitation
AED
automatic external defibrillator
VT
ventricular tachycardia
VF
ventricular fibrillation
SoL
signs of life
ADL
activities of daily living
DNR
do-not-resuscitate
BLS
basic life support
ALS
advanced life support
ED
emergency department
PCI
percutaneous coronary intervention
CI
confidence interval
IQR
interquartile range
SD
standard deviation
PEA
pulseless electrical activity. UMCG, University Medical Centre Groningen

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