Abstract
Background Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire. Methods From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). Results From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant (p=0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO2, pH, and hemoglobin. Recovery was seen in different underlying pathologies. Conclusion ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.
Highlights
Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor
By using extracorporeal membrane oxygenation (ECMO) as an adjunct to CPR, blood flow can be restored in patients with prolonged cardiac arrest in order to provide adequate perfusion, cerebral perfusion which often is the cause of death in this patient population. e development of extracorporeal cardiopulmonary resuscitation (ECPR) programs, incorporating ECMO as an adjunct to CPR, has shown encouraging results in patients with out-of-hospital cardiac arrest. ough limited studies, ECPR for out-of-hospital cardiac arrest has demonstrated survival to hospital discharge ranging from 4% to 45% with adequate neurologic recovery of CPC 1 or 2 [4,5,6,7,8,9,10,11,12,13,14,15]
Our ECPR program resulted in survival to hospital discharge of 25% with all patients having a CPC 1 or 2 at the time of discharge
Summary
Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between e Ohio State University Wexner Medical Center and Columbus Division of Fire. From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients
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