Abstract 13106: Improved Outcomes of Extracorporeal Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest - A Community-wide Evaluation

Abstract

Introduction: The patient outcome after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. It has been proposed to implement extracorporeal membrane oxygenation in order to assist CPR (ECPR) in OHCA. Objective: To investigate the effects of ECPR in emergency (ED) for OHCA. Methods: A prospective 4-year observational database collected from a community-wide OHCA registry in an urban EMS was studied. The EMS ambulance staffs were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and AED techniques. Outcomes included 2-hour and 24-hour sustained ROSC, survival (SD) and cerebral performance category scale (CPC) at discharge. OHCA receiving ECPR were included and their pre-hospital (pre-H) and hospital (H) characteristics and outcomes were evaluated by regression analysis. Results: In the 4 years among a total of 7,220 OHCA resuscitated in ED, ECPR was used 88 times (90% male, median age 54 [IQR 44-63]), 90% non-traumatic, 58.6% arrest witnessed, 50.6% with bystander CPR, up to 72.6% initial AED rhythm showing shockable, 54% with LMA (laryngeal mask airway), 5.7% with endotracheal intubation, 18.2% with pre-H iv epinephrine, and 12.5% of them received therapeutic hypothermia. Pre-H time intervals (min:sec, median [IQR]) were 04:38 [03:30-06:08] for response, 13:00 [10:05-16:00] for scene, and 03:08 [02:09-05:00] for transport. Only 10.2% of cases presented pre-H ROSC and 9.1% got ROSC upon H arrival. Outcomes were 88.6% for 2-hr ROSC, 69.3% for 24-hr ROSC, 39.1% for SD, and 21% for good CPC 1or2 respectively. Patients with CPC 1or2 tended to be younger (median age 46.8 vs. 55.9, p=0.04) and less with LMA (29.4 vs. 61.9%, p=0.02). Conclusions: ECPR can lead to survival and good neurological outcome in selected OHCA regardless of positive ROSC at pre-H or upon H arrival after EMS resuscitation. Elder age and pre-H LMA may be adverse to neurological outcome for OHCA with ECPR.