A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis

Lamhaut, Lionel; Hutin, Alice; Puymirat, Étienne; Jouan, Jérôme; Raphalen, Jean Herlé; Jouffroy, Romain; Jaffry, Murielle; Dagron, C.; An, Ke; Dumas, Florence; Marijon, Éloi; Bougouin, Wulfran; Tourtier, Jean Pierre; Baud, Frédéric J.; Jouven, Xavier; Danchin, Nicolás; Spaulding, Christian; Carli, Pierre

doi:10.1016/j.resuscitation.2017.04.014

Cited by 276 publications

(185 citation statements)

References 34 publications

(35 reference statements)

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“…Out‐of‐hospital cardiac arrest (OOHCA) is a leading cause of death worldwide, and despite improved training and technology, outcomes remain poor . Extracorporeal cardiopulmonary resuscitation (ECPR) is the application of veno‐arterial (VA) extracorporeal membrane oxygenation (ECMO) during cardiac arrest to augment traditional advanced life support (ALS) .…”

Section: Introductionmentioning

confidence: 99%

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Kilner

Stanton

Mazur

2019

Emerg Medicine Australasia

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Objective:We sought to identify out-of-hospital cardiac arrest (OOHCA) patients who might benefit from a future prehospital extracorporeal cardiopulmonary resuscitation (ECPR) programme in a moderately sized city. We described the 2014 OOHCA data and identified those who fulfilled hypothetical prehospital ECPR eligibility criteria. Methods: We identified patients aged 18-65 years in cardiac arrest, where CPR was commenced by paramedics on arrival. Traumatic cardiac arrest and end-of-life needs were patient exclusions. Patients were then included in one of three hypothetical 'ECPR eligible' groups. Patients were included in an 'ECPR eligible' group if they met author agreed criteria. Select patients in refractory VT/VF; pulseless electrical activity (PEA); and non-refractory VT/VF, or asystole with subsequent VT/VF or transient return of spontaneous circulation (ROSC), were assigned to three separate groups. Descriptive statistics were applied to each group. Outcomes of ECPR eligible patients who developed sustained ROSC after 20 min of conventional CPR were characterised. Results: A total of 206 patients were included. A significant positive association between initial shockable rhythm (odds ratio [OR] 15.32, confidence interval [CI] 5.4-43.2) and sustained ROSC, and PEA (OR 6.93, CI 2.4-19.8) and sustained ROSC, versus asystole was identified (P < 0.001). Sixty-eight (33%) patients were eligible for one of the hypothetical ECPR groups. Twelve (17.6%) of the 68 ECPR eligible patients developed sustained ROSC after 20 min of conventional CPR, with only two surviving neurologically intact to hospital discharge. Conclusion: Sixty-three (30.6%) patients could have derived benefit from a prehospital ECPR programme. Further analyses of prehospital ECPR logistics and economics are necessary to ensure that any future prehospital ECPR programme is effective and efficient.

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Section: Introductionmentioning

confidence: 99%

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Kilner

Stanton

Mazur

2019

Emerg Medicine Australasia

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“…There are several ongoing randomized studies that compare ECPR to conventional CPR in order to determine if this is an effective strategy in refractory CA (60). Interestingly, one of these ongoing trials aims to show that the ECPR can be provided on the resuscitation scene, outside the hospital (NCT 02527031) (61).…”

Section: When To Stop Initial Resuscitation Efforts?mentioning

confidence: 99%

Out-of-hospital cardiac arrest: prehospital management

2018

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(no more than 150 words)Sudden out of hospital cardiac arrest is the most time critical medical emergency. In this expert opinion and literature review, we consider important issues in the pre-hospital management of cardiac arrest. Successful resuscitation is reliant on a strong chain of survival drawn from the community, dispatch center, ambulance and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services staff. There is uncertainty about the best approaches for airway management and the effectiveness of current drug treatments. Prognostic factors and termination of resuscitation rules may guide the duration of a resuscitation attempt and decision to transport to hospital. If return of spontaneous circulation is achieved, the focus of treatment shifts to stabilization, restoring normal physiological parameters and transporting to hospital for on-going care.2

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“…In selected cases, however, transporting the patient still in cardiac arrest to a hospital for causal treatment of a potentially reversible cause of cardiac arrest is warranted [1,2]. Some EMS-systems prefer establishing extracorporeal cardiopulmonary resuscitation (eCPR) by implanting a veno-arterial extracorporeal membrane oxygenation (ECMO) on scene [3], whereas other concepts recommend transporting the patient to the hospital under ongoing CPR and establishing ECMO in-hospital [1]. Performing high-quality CPR during transport (consisting of evacuation from the scene to the ambulance, drive to the hospital, and transfer to treatment facility therein) can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

Drinhaus

Nüsgen²,

Adams

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: If transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto. We aimed to elaborate a strategy for evacuation of patients under ongoing CPR from an upper floor, comparing three different evacuation routes and manual and mechanical chest compressions. Methods: A CPR-training manikin recording CPR-quality was placed on the fifth floor and was evacuated to an ambulance via lift, turntable ladder, or staircase. Chest compressions were performed manually or with a mechanical CPR-device. Efficiency endpoints were compression depth and frequency, sufficiency of chest release, compared with European Resuscitation Council (ERC) Guidelines, and duration of the evacuation. Adverse outcomes were disconnection/dislocation of devices and hazards/accidents to the personnel.Results: For all evacuation routes, compression depth and frequency were significantly more compliant with ERCguidelines under mechanical CPR. Manual CPR was associated with considerable deviations from correct compression depth and frequency. Chest release only slightly differed between groups. Evacuation via lift under mechanical CPR was fastest and evacuation via turntable ladder under manual CPR was slowest. No device disconnections or accidents occurred, but hazard to personnel was perceived during evacuation via ladder under manual CPR. Conclusions:In this study, a mechanical CPR-device proved to deliver better CPR-quality during evacuation from an upper floor. If a lift accessible with a stretcher is available, this route should be preferred, regardless of manual or mechanical CPR. Turntable ladders can only be meaningfully used with mechanical CPR, otherwise CPR-quality is poor and hazard to the personnel is increased. Not all evacuation routes may be useable in a specific real-life scenario.

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A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis

Cited by 276 publications

References 34 publications

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Out-of-hospital cardiac arrest: prehospital management

Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

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