Abstract
ObjectiveOptimal management of out of hospital circulatory arrest (OHCA) remains challenging, in particular in patients who do not develop rapid return of spontaneous circulation (ROSC). Extracorporeal cardiopulmonary resuscitation (eCPR) can be a life-saving bridging procedure. However its requirements and feasibility of implementation in patients with OHCA, appropriate inclusion criteria and achievable outcomes remain poorly defined.DesignProspective cohort study.SettingTertiary referral university hospital center.PatientsHere we report on characteristics, course and outcomes on the first consecutive 254 patients admitted between August 2014 and December 2017.InterventioneCPR program for OHCA.Mesurements and main resultsA structured clinical pathway was designed and implemented as 24/7 eCPR service at the Charité in Berlin. In total, 254 patients were transferred with ongoing CPR, including automated chest compression, of which 30 showed or developed ROSC after admission. Following hospital admission predefined in- and exclusion criteria for eCPR were checked; in the remaining 224, 126 were considered as eligible for eCPR.State of the art postresuscitation therapy was applied and prognostication of neurological outcome was performed according to a standardized protocol.Eighteen patients survived, with a good neurological outcome (cerebral performance category (CPC) 1 or 2) in 15 patients. Compared to non-survivors survivors had significantly shorter time between collaps and start of eCPR (58 min (IQR 12–85) vs. 90 min (IQR 74–114), p = 0.01), lower lactate levels on admission (95 mg/dL (IQR 44–130) vs. 143 mg/dL (IQR 111–178), p < 0.05), and less severe acidosis on admission (pH 7.2 (IQR 7.15–7.4) vs. 7.0 (IQR6.9–7.2), p < 0.05). Binary logistic regression analysis identified latency to eCPR and low pH as independent predictors for mortality.ConclusionAn eCPR program can be life-saving for a subset of individuals with refractory circulatory arrest, with time to initiation of eCPR being a main determinant of survival.
Highlights
The prognosis of out of hospital circulatory arrest (OHCA) remains poor even in countries with well established emergency medical service (EMS)
An extracorporeal CPR (eCPR) program can be life-saving for a subset of individuals with refractory circulatory arrest, with time to initiation of eCPR being a main determinant of survival
Between August 2014 and December 2017, a total of 254 patients were admitted for eCPR mainly via EMS under ongoing mechanical CPR
Summary
The prognosis of out of hospital circulatory arrest (OHCA) remains poor even in countries with well established emergency medical service (EMS). A certain proportion of patients is refractory to advanced cardiac life support (ACLS) and the chances for a return of circulation (ROSC) decline with resuscitation time [1] In such inevitably fatal cases extracorporeal CPR (eCPR) using veno-arterial exracorporeal membrane oxygenation (ECMO) can provide life-saving bridging and enable identification of the course of circulatory arrest and causal therapy. Current guidelines, which fail to clarify ideal inclusion and exclusion criteria, recommend the invasive and aggressive approach of eCPR for very specific cases, and emphasize the necessity of a highly trained team [2] In this setting we have implemented an eCPR pathway at the Circulatory Arrest Center (CAC) of the CharitéUniversitätsmedizin Berlin (Campus Virchow Klinikum) in 2014. After intensive skill training of the staff and establishment of standardized procedures, the EMS was offered the opportunity to transfer patients without ROSC during ongoing CPR to the center for potential rescue eCPR
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
