Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol

被引:22
作者
Alm-Kruse, Kristin [1 ,2 ]
Sorensen, Gro [3 ,4 ]
Osbakk, Svein Are [4 ,5 ]
Sunde, Kjetil [2 ,4 ,6 ]
Bendz, Bjorn [2 ,3 ,4 ]
Andersen, Geir Oystein [7 ]
Fiane, Arnt [2 ,3 ,4 ]
Hagen, Ove Andreas [3 ,4 ]
Kramer-Johansen, Jo [2 ,4 ,5 ]
机构
[1] Oslo Univ Hosp, Dept Res & Dev, Div Emergencies & Crit Care, Oslo, Norway
[2] Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway
[3] Oslo Univ Hosp, Div Cardiovasc & Pulm Dis, Oslo, Norway
[4] Univ Oslo, Oslo, Norway
[5] Oslo Univ Hosp, Div Prehosp Serv, Oslo, Norway
[6] Oslo Univ Hosp, Div Emergencies & Crit Care, Oslo, Norway
[7] Oslo Univ Hosp, Dept Cardiol, Oslo, Norway
关键词
Out-of hospital cardiac arrest; Refractory cardiac arrest; Extracorporeal cardiopulmonary resuscitation; Advanced life support; EXTRACORPOREAL LIFE-SUPPORT; CARDIOPULMONARY-RESUSCITATION; CANDIDATES; DURATION; TIME;
D O I
10.1016/j.resuscitation.2021.01.038
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: To compare the outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA) fulfilling the criteria for extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an ECPR protocol, whether the patient received ECPR or not. Methods: We compared cardiac arrest registry data before (2014-2015) and after (2016-2019) implementation of the ECPR protocol. The ECPR criteria were presumed cardiac origin, witnessed arrest with ventricular fibrillation, bystander CPR, age 18-65, advanced life support (ALS) within 15 min and ALS > 10 min without return of spontaneous circulation (ROSC). The primary outcome was 30-day survival; the secondary outcomes were sustained ROSC, neurological outcome and the proportion of patients transported with ongoing ALS. Results: There were 1086 and 3135 patients in the pre- and post-implementation sample; 48 (4%) and 100 (3%) met the ECPR criteria, respectively. Of these, 21 (44%) vs. 37 (37%) were alive after 30 days, p = 0.4, and 30 (63%) vs. 50 (50%) achieved sustained ROSC, p = 0.2. All survivors in the pre-implementation sample had cerebral performance category 1-2 vs. 30 (81%) in the post-implementation sample, p = 0.03. Of the patients fulfilling the ECPR criteria, 7 (15%) and 26 (26%), p = 0.1, were transported with ongoing ALS in the pre- and post-implementation sample, respectively. Conclusions: There were no differences in 30-day survival or prehospital ROSC in patients with refractory OHCA before and after initiation of an ECPR protocol.
引用
收藏
页码:35 / 42
页数:8
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