Cardiac Catheter Laboratory Utilisation Following Introduction of an Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation (e-CPR) Programme for Out-of-Hospital Cardiac Arrest

Abstract

Refractory out-of-hospital cardiac arrest (r-OHCA) is associated with globally poor outcomes. Highly selected r-OHCA cases may be suitable for invasive, resource intensive interventions such as extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR). We sought to further understand whether ECPR implementation would have unintended effects on cardiac catheterisation laboratory (CCL) utilisation. This was an analysis of a prospective adult OHCA registry and Utstein-based outcome reporting with two distinct ‘pre’ and ‘post’ cohorts. The setting was a tertiary centre in Sydney, Australia. The pre-ECPR cohort comprised consecutive OHCA patients between 2016 and 2019 (prior to an ECPR program), and the post-ECPR cohort from mid-2020 and mid-2021 (post implementation of an ECPR program). There were 248 patients in the pre-ECPR cohort and 51 in the post-ECPR cohort. The groups had similar baseline characteristics. Sustained return of spontaneous circulation (ROSC) was obtained in 61 (24.6%) (pre) and 12 (23.5%) (post) OHCAs, respectively (p=0.86). Pre-ECPR, 47 (77%) received CCL during admission versus 8 (67%) post-ECPR (p=0.55). Early CCL (<24 h) was performed in 34 (56%) pre-ECPR patients versus 8 (67%) post-ECPR (p=0.57). In patients receiving early CCL, time from OHCA to CCL arrival was 188.38 min (SD 176.6) for pre-ECPR versus 130.38 min (SD 91.9) for the post-ECPR cohort (p=0.38). ECPR was attempted in 6/51 OHCA cases but only 1 patient survived to CCL. ECPR implementation did not appear to lead to unintended delayed to CCL interventions. All patients attending CCL post-ECPR implementation did so within 24 hours [[1]Yannopoulos D. Bartos J. Raveendran G. Walser E. Connett J. Murray T.A. et al.Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial.Lancet. 2020; 396: 1807-1816Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar].