Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial

Rob, Daniel; Šmalcová, Jana; Šmíd, Ondřej; Král, Aleš; Kovárník, Tomáš; Zemánek, David; Kaválková, Petra; Huptych, Michal; Komárek, Arnošt; Franěk, Ondřej; Havránek, Štěpán; Linhart, Aleš; Bělohlávek, Jan

doi:10.1186/s13054-022-04199-3

Cited by 53 publications

(51 citation statements)

References 27 publications

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“…Indeed, survival with good neurological recovery between shockable and non-shockable initial rhythms was significantly different, i.e., 49% vs. 8% in the invasive strategy and 33% vs. 2% in the standard ALS. Another secondary analysis also reported that ECPR improved 180-day survival in patients who did not achieve pre-hospital ROSC [ 29 ]. In fact, the overall 180-day survival in patients without pre-hospital ROSC increased from 1.2% in those receiving conventional ALS to 23.9% in those treated with ECPR [ 29 ].…”

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

“…Another secondary analysis also reported that ECPR improved 180-day survival in patients who did not achieve pre-hospital ROSC [ 29 ]. In fact, the overall 180-day survival in patients without pre-hospital ROSC increased from 1.2% in those receiving conventional ALS to 23.9% in those treated with ECPR [ 29 ]. Rapid deployment of veno-arterial extracorporeal circulation during ongoing CPR is, therefore, a promising approach for patients with refractory non-traumatic OHCA and has demonstrated improved outcomes in selected patients with favorable cardiac arrest circumstances, although limited data exist regarding the best practices for ECPR [ 14 ].…”

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

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One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Penna

Magliocca

Merigo

et al. 2023

JCM

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Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.

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Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Penna

Magliocca

Merigo

et al. 2023

JCM

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“…Some of the patients for whom resuscitation was initiated in a public space may have been transported to hospital under continued resuscitation, since declaring a patient dead “on the street” involves significant administrative work. With extracorporeal cardiopulmonary resuscitation (ECPR) gaining more and more importance as a rescue method in refractory OHCA ( 32 ), the question of how and when to transport a patient with OHCA will still be the subject of research in the years to come.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of out-of-hospital cardiac arrest is still based on quick activation of the chain of survival

Borgstedt

Schaller

Goudkamp

et al. 2023

Front. Public Health

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Background and goal of studyCardiopulmonary resuscitation (CPR) in prehospital care is a major reason for emergency medical service (EMS) dispatches. CPR outcome depends on various factors, such as bystander CPR and initial heart rhythm. Our aim was to investigate whether short-term outcomes such as the return of spontaneous circulation (ROSC) and hospital admission with spontaneous circulation differ depending on the location of the out-of-hospital cardiac arrest (OHCA). In addition, we assessed further aspects of CPR performance.Materials and methodsIn this monocentric retrospective study, protocols of a prehospital physician-staffed EMS located in Munich, Germany, were evaluated using the Mann–Whitney U-test, chi-square test, and a multifactor logistic regression model.Results and discussionOf the 12,073 cases between 1 January 2014 and 31 December 2017, 723 EMS responses with OHCA were analyzed. In 393 of these cases, CPR was performed. The incidence of ROSC did not differ between public and non-public spaces (p = 0.4), but patients with OHCA in public spaces were more often admitted to the hospital with spontaneous circulation (p = 0.011). Shockable initial rhythm was not different between locations (p = 0.2), but defibrillation was performed significantly more often in public places (p < 0.001). Multivariate analyses showed that hospital admission with spontaneous circulation was more likely in patients with shockable initial heart rhythm (p < 0.001) and if CPR was started by an emergency physician (p = 0.006).ConclusionThe location of OHCA did not seem to affect the incidence of ROSC, although patients in public spaces had a higher chance to be admitted to the hospital with spontaneous circulation. Shockable initial heart rhythm, defibrillation, and the start of resuscitative efforts by an emergency physician were associated with higher chances of hospital admission with spontaneous circulation. Bystander CPR and bystander use of automated external defibrillators were low overall, emphasizing the importance of bystander education and training in order to enhance the chain of survival.

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“…Pensando, ainda, em reverter os mecanismos de choque o quanto antes, VA-ECMO poderia ter sido implementada durante a PCR do paciente. Uma subanálise do estudo OHCA (Out-hospital Cardiac Arrest) de Praga concluiu que o emprego de VA-ECMO após PCR refratária trouxe maior benefício de sobrevivência em 180 dias do que condução padrão baseada em suporte a vida avançado (ACLS), principalmente em paciente com ritmo chocável inicial, idade mais jovem e menor tempo de ressuscitação (ROB et al, 2022). Contudo trata-se de sub-análise de um estudo randomizado e, portanto, sujeito a variáveis de confusão (ROB et al, 2022).…”

Section: Método E Discussãounclassified