Eligibility criteria for extracorporeal cardiopulmonary resuscitation at Auckland City Hospital: A retrospective cohort study

Abstract

Objective: Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising adjunct to routine advanced cardiac life support. Growing worldwide interest in ECPR-use has seen more tertiary centres offering ECPR programmes. New Zealand's nationwide extracorporeal membranous oxygenation service is provided at Auckland City Hospital (ACH). Despite the potential benefits of ECPR, it is currently only offered on an ad hoc basis. It remains unknown whether ACH would manage sufficient numbers of patients to warrant an ECPR programme. Methods: A 12-month retrospective cohort study of the medical records of patients who were managed for cardiac arrest in the resuscitation room of the ED was conducted. Patient characteristics and clinical outcomes were analysed descriptively and audited against a unique set of criteria for a hypothetical ECPR programme. Results: Between 1 July 2018 and 30 June 2019, 286 patients died or had a cardiac arrest for which they were managed at ACH. Sixty-five of these patients had an in-hospital cardiac arrest in the ED. Seven (10.8%) of these patients were deemed eligible for hypothetical ECPR. Only one of these seven patients survived to hospital discharge with full neurological recovery. Conclusions: An ECPR programme at ACH using standardised and agreed criteria may benefit a small number of patients and improve rates of survival to hospital discharge with preservation of neurological function. An ECPR guideline would help clarify for referring services cases that are appropriate for extracorporeal membranous oxygenation consideration, rather than discussing on an ad hoc basis.

Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study

“…Iwashita et al . [ 20 ] and Olander et al . [ 26 ] found an ECPR eligibility rate in IHCA patients of 5.5–12.0%.…”

“…Previous research has reported that around 10% of IHCA and 10% of OHCA patients are eligible to ECPR [17–20]. However, the proportion of patients eligible to ECPR in the Netherlands has not been investigated.…”

Extracorporeal cardiopulmonary resuscitation as a standard of care in the future: a literature review

“…The outcome measures evaluated across the studies mainly comprised ROSC (return of spontaneous circulation), survival, neurological outcomes, eligibility for ECPR, and time to extra corporeal membrane oxygenation (ECMO). Furthermore, among the 12 studies analyzed, five studies reported an increased long-term neurologically intact survival with the use of ECPR, four of which were OHCA, 32,34,37,39 while one evaluated ECPR in IHCA 35 (Table 3 in Supplemental Material shows the studies' design, objectives, interventions, outcomes, and results with neurological outcomes. )…”

“…47 While our literature review evaluated the criteria under which ECPR should be performed, four studies reported the need to evaluate CA patients for eligibility to see if they fit for ECPR therapy. 35,39,41,42 These studies report higher survival associated with carefully selected patients after meeting inclusion criteria. 39 These results are significant as they demonstrate the need to make early patient selection conceivable and necessary prior to ECPR therapy.…”

Extracorporeal membrane oxygenation cardiopulmonary resuscitation: Resisting the inevitable

“…In this issue of Emergency Medicine Australasia , Iwashita et al . performed an audit of in‐hospital cardiac arrests that occurred in the Auckland City Hospital ED to determine the potential number of eligible patients for ECPR based on theoretical inclusion criteria 22 . A total of 65 patients were identified to have had an in‐hospital cardiac arrest within the ED, of which seven would be eligible for ECPR.…”