scholarly journals 156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

2020 ◽  
Vol 37 (12) ◽  
pp. 825.1-825
Author(s):  
Ed Barnard ◽  
Daniel Sandbach ◽  
Tracy Nicholls ◽  
Alastair Wilson ◽  
Ari Ercole
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Discharge Data ◽  
Successful Resuscitation ◽  
Bystander Cpr ◽  
Number Percentage ◽  
Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

scholarly journals Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

2019 ◽  
Vol 36 (6) ◽  
pp. 333-339 ◽  
Author(s):  
Ed B G Barnard ◽  
Daniel D Sandbach ◽  
Tracy L Nicholls ◽  
Alastair W Wilson ◽  
Ari Ercole
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Neurological Injury ◽  
Successful Resuscitation ◽  
Traumatic Cardiac Arrest ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement.MethodsAn analysis of 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission and hospital discharge.ResultsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95% CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA.ConclusionNTCA and TCA are clinically distinct entities with different predictors for outcome—future OHCA reports should aim to separate arrest aetiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

Abstract 164: Comparison of Tracheal Intubation vs. Supraglottic Airway Following Pediatric Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Maryam Y Naim ◽  
Heather Griffis ◽  
Robert A Berg ◽  
Richard N Bradley ◽  
Matthew L Hansen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
Supraglottic Airway ◽  
Secondary Outcome ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: There are few data comparing Tracheal Intubation (TI) and SupraGlottic Airway (SGA) following pediatric out of hospital cardiac arrest (OHCA). Hypothesis: TI is associated with improved outcomes compared to SGA following pediatric OHCA. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by Emergency Medical Services (EMS). To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and initial rhythm. Primary outcome was neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Secondary outcome was survival to hospital discharge. Results: Of 2653 cardiac arrests evaluated, 2178 (82.1%) had TI and 475 (17.9%) had SGA placed during OHCA. 835 (31.2%) arrests were resuscitated by agencies used bag valve mask (BVM) and TI and 1818 (68.0%) arrests had agencies that used all 3 airway types (BVM/TI/SGA). Overall, unadjusted favorable neurological survival was 5.7% for TI and 5.3% for SGA, p=0.67 and survival to hospital discharge was 7.9% for TI and 7.5% for SGA, p=0.73. In multivariable analysis (adjusting for age, sex, race/ethnicity, bystander witness, bystander CPR, initial rhythm, AED use, year of arrest, and agency category), SGA was associated with lower neurologically favorable survival compared to TI (adjusted proportion 3.7% vs. 6.3%, OR 0.49, p=0.01), and lower survival to hospital discharge (5.5% vs. 8.5%, OR 0.57, 95% CI 0.36, 0.89). These results were robust on tests for unmeasured confounding and covariate balance; propensity analysis neurologically favorable survival 4.4% vs.7.6% (OR 0.54, 95% CI 0.30, 0.96), survival to hospital discharge 6.6% vs.10.5% (OR 0.58, 95% CI 0.35, 0.95); and entropy balance neurologically favorable survival 5.0 % vs. 9.7% for ETI (OR 0.44, 95% CI 0.27, 0.72), survival to hospital discharge 7.3% vs.12.5% (OR 0.51, 95% CI 0.34, 0.78). Conclusion: In pediatric OHCA, TI, compared with SGA advanced airway management is associated with improved neurologically favorable survival and survival to hospital discharge.

Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Furqan B Irfan ◽  
Zain A Bhutta ◽  
Tooba Tariq ◽  
Loua A Shaikh ◽  
Pregalathan Govender ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Incidence Rate ◽  
Hospital Discharge ◽  
Middle Eastern ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Final Analysis ◽  
National Registry ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

scholarly journals Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (47) ◽  
pp. 3824-3834 ◽  
Author(s):  
Marieke T Blom ◽  
Iris Oving ◽  
Jocelyn Berdowski ◽  
Irene G M van Valkengoed ◽  
Abdenasser Bardai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Sex Differences ◽  
Hospital Admission ◽  
Survival Rates ◽  
Hospital Treatment ◽  
Care Utilization ◽  
Entire Study ◽  
Hospital Cardiac Arrest ◽  
Resuscitation Attempt

AbstractAimsPrevious studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA.Methods and resultsWe performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P < 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate.ConclusionIn case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics.

scholarly journals Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001805
Author(s):  
Laura Helena van Dongen ◽  
Marieke T Blom ◽  
Sandra C M de Haas ◽  
Henk C P M van Weert ◽  
Petra Elders ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Heart Disease ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Lower Proportion ◽  
Initial Rhythm ◽  
Multivariable Regression ◽  
Medical Histories ◽  
Underlying Mechanisms ◽  
Hospital Cardiac Arrest

AimThis study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms.MethodsA retrospective cohort study in 3760 OHCA patients from the Netherlands (2010–2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm.ResultsOverall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)).ConclusionHaving pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.

Abstract 13209: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Luke A Wohlford ◽  
Bruce J Barnhart ◽  
Daniel W Spaite ◽  
Joshua B Gaither ◽  
Amber D Rice ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Law Enforcement ◽  
Cardiopulmonary Resuscitation ◽  
Patient Care ◽  
Hospital Discharge ◽  
System Response ◽  
Healthcare Facilities ◽  
Bystander Cpr ◽  
Provision Of Care ◽  
Hospital Cardiac Arrest

Background: Little is known about the provision of care by law enforcement (LE) personnel within modern EMS systems. We evaluated LE performance of bystander CPR (BCPR) and associated outcomes in OHCA across Arizona. Methods: A total of 5,654 OHCA cases (1/1/2019-12/31/2019) were evaluated using the Save Hearts in Arizona Registry and Education (SHARE) cardiac arrest registry. Data were abstracted from all EMS patient care records (PCRs). If two parties provided BCPR, the first to give compressions was considered the provider for this analysis. Cases identified as “Stranger” or “Unknown” BCPR were manually evaluated for narrative data to identify BCPR provider when possible. Results: BCPR was provided in 2285 cases [48.8%; (95% CIs 47.4%, 50.3%)] after excluding 850 cases that occurred in healthcare facilities where personnel are duty-bound to provide CPR. LE provided BCPR in 444 patients [19.4% (17.8%, 21.1%)], second only to family/spouse [1143 pts; 50.0% (48.0%, 52.1%)]. Overall, 279 patients survived to hospital discharge [12.2%, (10.9%, 13.6%)]. The Table shows the rates of BCPR in each provider category and the associated rates of survival. Of note is that the rate of bystander AED use was more than four times higher in LE BCPR [6.3% (4.23%, 8.99%)] than family-provided BCPR [1.5% (0.87%, 2.37%; p < 0.0001)], but was still very low. Conclusions: In this statewide study that included more than 130 EMS agencies from frontier to urban settings, LE personnel were frequently involved in the care of OHCA patients within the 911 system response. To our knowledge, this magnitude of provision of BCPR by LE (nearly one in five BCPR cases) has not been reported previously. Furthermore, the consequential rate of LE response to OHCA provides the opportunity to significantly increase AED use. Our findings support the widespread and intentional training of LE in CPR and AED use and has the potential to improve survival in diverse settings.

Abstract 14172: Impact of Sex on Survival With Preserved Neurologic Function Following Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Fatima Lakhani ◽  
Brendan Caprio ◽  
Elena Deych ◽  
David L Brown
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Menopausal Status ◽  
Favorable Outcome ◽  
Categorical Variables ◽  
Female Sex ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Neurologic Function ◽  
Hospital Cardiac Arrest

Introduction: Females experience worse survival than males following out-of-hospital cardiac arrest (OHCA). Proposed explanations include previous observations that females less often have an initial shockable rhythm or a witnessed arrest and less often receive bystander CPR. Methods: We utilized a prospective, population-based registry of patients experiencing OHCA responded to by EMS from 2011-2015. We included patients 18 years or older who were admitted to the hospital. Univariate comparisons were performed with chi-squared test for categorical variables and t-test for age. Additional analysis compared outcomes stratified by age > 50 years as a surrogate for menopausal status. A multivariate logistic regression model was constructed to evaluate the independent association of sex with outcomes. The primary outcome was survival to hospital discharge with Modified Rankin Score (MRS) ≤3. Results: Of 13,651 patients, 4894 were female and 8757 were male. The average age was 65 years for females and 64.2 years for males (P=0.005). Females were less likely than males to arrest in a public location (13% vs 27%; P <0.001), have bystander witnessed arrest (48% vs 57%; P <0.001), receive bystander CPR (44% vs 49%; P <0.001), have an initial shockable rhythm (29% vs 48%; P <0.001), have achieved ROSC upon ED arrival (76% vs 78%; P=0.014), have an ED arrival time less than 30 minutes from dispatch call (10% vs 12% P=0.008). Among males, 27% had a favorable outcome compared to 16% of females (P <0.0001). Among individuals of age ≤ 50 years, 31% of males and 26% of females had a favorable outcome (P= 0.004). Among those of age > 50 years, 26% of males and 14% of females had a favorable outcome (P <0.0001). After adjustment for differences in age and presentation, female sex was found to be independently associated with lower rates of survival with intact neurologic function (OR 0.79, 95% CI 0.71-0.89, P =0.0001). Conclusions: Compared to males, females have less favorable OHCA presentations and worse survival to hospital discharge with preserved neurologic function. However, even after adjustment for the differences in presentation, female sex remains a significant predictor of worse survival with preserved neurologic function.

P2829Arrhythmia burden during long-term follow-up in a large cohort of patients surviving out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Caro Codon ◽  
L Rodriguez Sotelo ◽  
J R Rey Blas ◽  
O Gonzalez Fernandez ◽  
S O Rosillo Rodriguez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Atrial Arrhythmias ◽  
Coronary Syndrome ◽  
Long Term Follow Up ◽  
Index Hospital ◽  
Hospital Cardiac Arrest

Abstract Background Data regarding incidence of ventricular (VA) and atrial arrhythmias (AA) in survivors after out-of-hospital cardiac arrest (OHCA) are scarce. Purpose To assess incidence of VA and AA in OHCA patients during long-term follow-up and to identify relevant predictive factors during the index hospital admission. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA from August 2007 to January 2019 and surviving until hospital discharge were included. Cox proportional hazard models and logistic regression analysis were used to investigate clinical variables related to the incidence of VA and AA. Results The final analysis included 201 patients. Mean age was 57.6±14.2 years and 168 (83.6%) were male. The majority of patients experienced witnessed arrests related to shockable rhythms (176, 87.6%). Thirty-six patients (17.9%) died after a median follow-up of 40.3 months (18.9–69.1), but only 4 presented another cardiac arrest. Eighteen patients (9.0%) suffered new VA and 37 (18.4%) developed atrial fibrillation/atrial flutter. History of coronary heart disease [HR 3.59 (1.37–9.42), p=0.010] and non-acute coronary syndrome-related arrhythmia [HR 5.17 (1.18–22.60), p=0.029] were independent predictors of VA during follow-up. The optimal predictive model for atrial arrhythmias included age at the time of OHCA, LVEF at hospital discharge and non-acute coronary syndrome-related arrhythmias (p<0.001). Table 1 Variable Without VA With VA p value Age, mean ± DS, years 57.4±14.2 60.8±14.7 0.336 Male sex, n (%) 150 (83.3) 15 (83.3) 1.000 Coronary heart disease, n (%) 36 (20.0) 11 (61.1) <0.001 Cardiomyopathy, n (%) 27 (15.0) 8 (44.4) 0.006 Shockable rhythm, n (%) 157 (87.2) 16 (88.9) 1.000 ACS-related arrhythmia (Primary VF), n (%) 83 (46.1) 2 (11.1) 0.004 LVEF at hospital discharge (%) 47.5±13.9 38.3±16.5 0.010 Death during follow-up 32 (17.8) 3 (16.7) 0.603 Cardiac arrest during follow-up 2 (1.1) 2 (11.1) 0.042 CV hospital admission during follow-up 39 (21.7) 14 (77.8) <0.001 Atrial arrhythmias during follow-up 28 (15.6) 9 (50.0) <0.001 Figure 1 Conclusions Despite low incidence of recurrent cardiac arrest, OHCA survivors face a high incidence of VA and AA. Several clinical characteristics during index hospital admission may be useful to identify patients at high risk.

scholarly journals Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 453-460 ◽  
Author(s):  
Brian Grunau ◽  
Frank Xavier Scheuermeyer ◽  
Dion Stub ◽  
Robert H. Boone ◽  
Joseph Finkler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Secondary Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
High Performing ◽  
Canadian Health ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest ◽  
Refractory Cardiac Arrest

AbstractObjectiveExtracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation.MethodsWe performed a secondary analysis from a 52-month prospective registry of consecutive adult non-traumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge.ResultsOf 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge.ConclusionIn our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.

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