Evaluating the potential impact of an emergency department extracorporeal resuscitation (ECPR) program: a health records review

Abstract

ObjectivesExtracorporeal cardiopulmonary resuscitation in refractory cardiac arrest (ECPR) is an emerging resuscitative therapy that has shown promising results for selected patients who may not otherwise survive. We sought to identify the characteristics of cardiac arrest patients presenting to our institution to begin assessing the feasibility of an ECPR program.MethodsThis retrospective health records review included patients aged 18–75 years old presenting to our academic teaching hospital campuses with refractory nontraumatic out-of-hospital or in-emergency department (ED) cardiac arrest over a 2-year period. Based on a scoping review of the literature, both “liberal” and “restrictive” ECPR criteria were defined and applied to our cohort.ResultsA total of 179 patients met inclusion criteria. Median age was 60 years, and patients were predominantly male (72.6%). The initial rhythm was ventricular tachycardia/ventricular fibrillation in 49.2%. The majority of arrests were witnessed (69.3%), with immediate bystander CPR performed on 53.1% and an additional 12% receiving CPR within 10 minutes of collapse. Median prehospital time was 40 minutes (interquartile range, 31–53.3). Two-thirds of patients (65.9%) were identified as having a reversible cause of arrest and favorable premorbid status was identified in nearly three quarters (74.3%). Our two sets of ECPR inclusion criteria revealed that 33 and 5 patients (liberal and restrictive criteria, respectively), would have been candidates for ECPR.ConclusionAt our institution, we estimate between 6% and 40% of ED refractory cardiac arrest patients would be candidates for ECPR. These findings suggest that the implementation of an ECPR program should be explored.

Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients

“…Grunau et al found that 10.2% of OHCA patients presenting to Vancouver EDs were eligible for ECPR (10). In Ottawa, a similar study identi ed that 6-15% of their OHCA patients were eligible for ECPR (16). A retrospective study conducted in Saskatoon in 2016 found that 14% of non-survivors of OHCA represented suitable candidates for ECPR (9,15).…”

Ethik der Reanimation und Entscheidungen am Lebensende

“…Zur Untermauerung unserer Erkenntnisse haben wir sechs systematische [ 164 – 169 ], vier narrative Reviews [ 170 – 173 ] und 13 Beobachtungsstudien [ 76 , 148 , 168 , 174 – 183 ] zu diesem Thema gefunden. Andere Quellen wie Kommentare und ethische Dissertationen wurden als indirekte Informationen angesehen.…”

“…Sie urteilten, dass dies machbar ist und sowohl das neurologisch intakte Überleben als auch die Organspende durch Nichtüberlebende erhöhen könnte. Die Implementierung in vorhandene Rettungsdienstsysteme ist eine Herausforderung und erfordert detaillierte Protokolle für die Patientenauswahl und den Transport [ 168 , 181 – 183 ]. Die Ethik-Autorengruppe stellt fest, dass mehr Forschung zur Patientenauswahl, zu veränderbaren Ergebnisvariablen, zum Nutzen-Risiko-Verhältnis und zur Kostenwirksamkeit der E‑CPR dringend erforderlich ist.…”

Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients

“…There have been several recent Canadian studies, evaluating the number of patients eligible for ECPR [ 10 , 15 , 16 ]. Grunau et al found that 10.2% of OHCA patients presenting to Vancouver EDs were eligible for ECPR [ 10 ].…”

“…Grunau et al found that 10.2% of OHCA patients presenting to Vancouver EDs were eligible for ECPR [ 10 ]. In Ottawa, a similar study identified that 6–15% of their OHCA patients were eligible for ECPR [ 16 ]. A retrospective study conducted in Saskatoon in 2016 found that 14% of non-survivors of OHCA represented suitable candidates for ECPR [ 9 , 15 ].…”