Abstract 172: Initial Rhythm and Rhythm at Moment of Transport Related to Survival in Potential ECPR Patients in the Netherlands

Abstract

Purpose: Extracorporeal cardiopulmonary resuscitation (ECPR) shows promising results in patients found in ventricular fibrillation (VF) without return of spontanous circulation (ROSC) on scene. Insight in rhythm at moment of transport and survival of potential ECPR patients could help to identify which patients should be transported for ECPR. Methods: Data of potential ECPR patients (shockable first rhythm, witnessed arrest, bystander CPR and age 18-70 year) transported without ROSC between 2012 and 2016 in the Amsterdam Resuscitation Study (ARREST) database were analyzed. Initial rhythm and rhythm at moment of transport was related to 30-day survival. Results: Of 5872 OHCA patients with attempted resuscitation, 649 (11%) were transported with ongoing CPR. Of these, 162 (25%) were considered potential ECPR patients and 153 cases with complete data were analysed. Thirteen of these 153 patients (9%) were alive at 30 days. At start of transport, 68 patients (44%) had VF/VT, 58 (38%) PEA and 27 (18%) asystole. Of these, 10, 2 and 1 patients survived, respectively (figure). 30-day survival of patients with a shockable rhythm at start of transport was significantly higher compared to non-shockable rhythms (15% vs 3%, p=0.014). During transport 10 of 153 patients (7%) achieved ROSC, and 3 patients (30%) survived. VF/VT at start of transport identified 10/13 (77%) of all survivors. In patients without ROSC at hospital arrival, VF/VT also resulted in the highest survival (13%). Conclusion: In ECPR candidate patients, a shockable rhythm at the moment of transport (44%) identified 77% of patients surviving 30 days.