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

Brian Grunau; Jamil Bashir; Anson Cheung; Robert Boone; Ken McDonald; Frank Scheuermeyer; Joel Singer; Sandra Jenneson; Ron Straight; Brian Twaites; Luke Harris; Scott Haig; Devin Harris; Richard Vandegriend; Hussein Kanji; Jim Christenson

doi:10.1016/j.resuscitation.2021.08.004

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

Resuscitation. 2021 Oct:167:22-28. doi: 10.1016/j.resuscitation.2021.08.004. Epub 2021 Aug 9.

Authors

Brian Grunau¹, Jamil Bashir², Anson Cheung², Robert Boone³, Ken McDonald⁴, Frank Scheuermeyer⁵, Joel Singer⁶, Sandra Jenneson⁷, Ron Straight⁸, Brian Twaites⁸, Luke Harris², Scott Haig⁸, Devin Harris⁹, Richard Vandegriend¹⁰, Hussein Kanji¹¹, Jim Christenson⁵

Affiliations

¹ 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.
² St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada.
³ St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiology, University of British Columbia, Canada.
⁴ St. Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada.
⁵ 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.
⁶ Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada.
⁷ 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.
⁸ British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada.
⁹ Department of Emergency Medicine, University of British Columbia, Canada; Kelowna General Hospital, Kelowna, B.C., Canada.
¹⁰ Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada.
¹¹ Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada; Vancouver General Hospital, Vancouver, B.C., Canada.

PMID: 34384821
DOI: 10.1016/j.resuscitation.2021.08.004

Abstract

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.

Keywords: Extracorporeal membrane oxygenation; Heart arrest; Out-of-hospital cardiac arrest.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cardiopulmonary Resuscitation*
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Randomized Controlled Trials as Topic
SARS-CoV-2