Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.

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Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041917 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041917

Author(s):

Fei Shao ◽

Haibin Li ◽

Shengkui Ma ◽

Dou Li ◽

Chunsheng Li

Keyword(s):

Cardiac Arrest ◽

Urban Areas ◽

Patient Characteristics ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Term Survival ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

ObjectiveThe purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.DesignCross-sectional study.MethodsAdult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.ResultsOverall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).ConclusionSurvival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

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Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽

10.1161/circ.130.suppl_2.219 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Markus Keferböck ◽

Philip Datler ◽

Mario Krammel ◽

Elisabeth Lobmeyer ◽

Alexander Nürnberger ◽

...

Keyword(s):

Cardiac Arrest ◽

Outcome Measures ◽

Primary Outcome ◽

Sudden Cardiac Arrest ◽

Cerebral Performance Category ◽

Medical Personnel ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

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Abstract 284: Association of Neurological Outcome and Survival With Interventions by Bystander and Emergency Medical Service for Unwitnessed Out-of-Hospital Cardiac Arrest Patient; Results From the JCS-ReSS Study

Circulation ◽

10.1161/circ.138.suppl_2.284 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Chisato Okamoto ◽

Yoshio Tahara ◽

Atsushi Hirayama ◽

Satoshi Yasuda ◽

Teruo Noguchi ◽

...

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Emergency Medical Service ◽

Neurological Outcome ◽

Medical Service ◽

Favorable Outcome ◽

Shockable Rhythm ◽

Advanced Airway ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Although studies have shown that bystander cardiopulmonary resuscitation (CPR) in witnessed out-of-hospital cardiac arrest (OHCA) is associated with better neurological prognosis, whether bystander and Emergency Medical Service (EMS) interventions are associated with prognosis in unwitnessed OHCA patients is not fully elucidated. We aimed to investigate the prognostic importance of bystander and EMS interventions among unwitnessed OHCA patients in Japan. Methods and Results: This study was a nation-wide population-based observational study of OHCA in Japan from 2011 to 2015 based on data from the All-Japan Utstein Registry. The outcome measures were neurological outcome and survival at 30-day. The neurologically favorable outcome was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2. First, to investigate the effectiveness of bystander interventions, we included 105,655 unwitnessed cardiogenic OHCA patients (aged 18-80 years). Of these, 1,614 (1.5%) showed neurologically favorable outcome and 3,273 (3.1%) survived at 30-day. Multivariate logistic regression analysis adjusting for age, sex, geographical region, year and EMS response time showed that bystander CPR was associated with neurologically favorable outcome (adjusted odds ratio [aOR] 1.49, 95% CI 1.35-1.65, P<0.001). Additionally, to investigate the effectiveness of EMS interventions for patients with non-shockable rhythm, we examined 43,342 patients who were performed public CPR and had the initial rhythm of pulseless electrical activity (PEA) or asystole. Of these, 101 (0.2%) showed neurologically favorable outcome and 453 (1.0%) were survival at 30-day. Advanced airway management by EMS was negatively associated with neurologically favorable outcome (aOR 0.55, 95% CI 0.37-0.81, P=0.003) and administration of epinephrine by EMS was associated with survival (aOR 2.35, 95% CI 1.89-2.92, P<0.001). Conclusions: Among unwitnessed OHCA patients, bystander CPR was associated with neurologically favorable prognosis. For unwitnessed OHCA patients with non-shockable rhythm, epinephrine administration was associated with survival, but advanced airway management was negatively associated with neurological outcome.

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Abstract 24: Sex Differences in Outcomes After Out-of-Hospital Cardiac Arrest Patients: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial

Circulation ◽

10.1161/circ.138.suppl_2.24 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Purav Mody ◽

Ambarish Pandey ◽

Rohan Khera ◽

Colby Ayers ◽

Mark Link ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Regression Models ◽

Neurological Function ◽

Future Studies ◽

Logistic Regression Models ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Sex Disparities ◽

Hospital Cardiac Arrest

Background: Previous studies examining sex-based differences among out-of-hospital cardiac arrest (OHCA) patients have been conflicting. Methods: Patients with OHCA enrolled in the Continuous Chest Compression trial between 2011 and 2016 were included in the present analysis. Hierarchical multivariable logistic regression models were constructed to evaluate the association between sex and sustained ROSC i.e. ROSC on ER arrival, discharge survival and survival with favorable neurological function after adjustment for age, witnessed status, presenting rhythm, public location, bystander CPR, resuscitation duration, and EMS response time. Results: Among 22,540 OHCA patients, 8,099 (35.9%) were women. Women were older (median 71 vs. 67 years), received less bystander CPR (45% vs. 47%), and had a lower proportion of cardiac arrests that were witnessed (39% vs. 45%) or had an initial shockable rhythm (15% vs. 28%, p<= 0.001 for all). There was no difference in sustained ROSC rates (24.7% vs. 24.8%, p=0.7) but discharge survival (6.5% vs. 10.3%, p<0.001) and survival with favorable neurological function (4.9 vs. 8.6%, p<0.001) were significantly lower in women (vs. men). In adjusted analysis, women (vs. men) had significantly higher likelihood of sustained ROSC ( Table ) but no difference in likelihood of discharge survival and survival with favorable neurological function. In the adjusted landmark analysis beginning after achieving ROSC, women had significantly lower likelihood of discharge survival and survival with favorable neurological function ( Table ) . Conclusions: Among resuscitated OHCA patients, women have a higher likelihood of achieving sustained ROSC despite a higher burden of poor prognostic factors. However, after successful ROSC, the likelihood of discharge survival is significantly lower in women (vs. men). Future studies are needed to understand how care provided post-ROSC may modify the sex-disparities in discharge survival outcomes.

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How many prehospital defibrillation attempts should be performed in out-of-hospital cardiac arrest patients with shockable rhythm?

10.21203/rs.3.rs-106512/v1 ◽

2020 ◽

Author(s):

Byuk Sung Ko ◽

Youn-Jung Kim ◽

Kap Su Han ◽

You Hwan Jo ◽

Jonghwan Shin ◽

...

Keyword(s):

Cardiac Arrest ◽

Odds Ratio ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurologic Outcome ◽

Secondary Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Shockable Rhythm ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Abstract Background: Early defibrillation is vital to improve outcomes after out-of-hospital cardiac arrest (OHCA) with shockable rhythm. Currently, there is no agreed consensus on the number of defibrillation attempts before transfer to a hospital. This study aimed to evaluate the correlation between the number of defibrillations on the prehospital return of spontaneous circulation (ROSC).Methods: A multicenter, prospective, observational registry-based study was conducted for OHCA in patients with presumed cardiac etiology that underwent prehospital defibrillation between October 2015 and June 2017. The primary outcome was prehospital ROSC, and the secondary outcome was a good neurologic outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Results: Among 2,155 OHCA patients’ data, 178 patients with missing data were excluded, a total of 1,983 OHCA patients who received prehospital defibrillation were included. The median age was 61 years and prehospital ROSC was observed in 738 patients (37.2%). The median time from arrest to first defibrillation was 10 (interquartile range: 7-15) minutes. The cumulative ROSC rates and good neurologic outcome from the initial defibrillation to the sixth defibrillation were 43%, 68%, 81%, 90%, 95%, 98% and 42%, 66%, 81%, 90%, 95%, 98%, respectively. After clinical characteristics adjustment and time to defibrillation, the number of defibrillations were independently associated with ROSC (odds ratio 0.81 95% CI 0.76-0.86) and good neurologic outcome (odds ratio 0.86 95% CI 0.80-0.91). Moreover, subgroup analysis results with patients that underwent the initial defibrillation within 10 minutes from arrest were consistent (95% up to five times).Conclusion: More than 95% of prehospital ROSC was achieved within five times of defibrillation in OHCA patients. This result provides a basis for the ideal number of defibrillation attempts before transfer to hospital with the possibility of extracorporeal cardiopulmonary resuscitation in these refractory ventricular fibrillation patients.

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Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

10.21203/rs.3.rs-31150/v1 ◽

2020 ◽

Author(s):

Atsunori Tanimoto ◽

Kazuhiro Sugiyama ◽

Maki Tanabe ◽

Kanta Kitagawa ◽

Ayumi Kawakami ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Cerebral Performance Category ◽

Low Flow ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Emergency Medical Service Personnel ◽

Good Outcome ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

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Out of Hospital Cardiac Arrest Management by First Responders: Retrospective Review of a Fire Fighter First Responder Program

Australasian Journal of Paramedicine ◽

10.33151/ajp.11.5.59 ◽

2014 ◽

Vol 11 (5) ◽

Cited By ~ 1

Author(s):

Christian Winship ◽

Malcolm Boyle ◽

Brett Williams

Keyword(s):

Cardiac Arrest ◽

Response Times ◽

Significant Rise ◽

First Responder ◽

Median Response ◽

Fire Fighters ◽

Shockable Rhythm ◽

Medical Response ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

IntroductionOver 9,500 people die annually in Australia from sudden cardiac arrest, with strong evidence suggesting early high quality CPR and early counter shock being paramount for improving survival from cardiac arrest. It has also been shown that first responder programs have been able to reduce response times and increase survival rates for out-of-hospital cardiac arrest. The objective of this study was to examine data from the first seven years of an Australian out-of-hospital cardiac arrest first responder program where fire fighters provided basic life support.MethodsThis study was a retrospective cohort study of all cardiac arrests attended by the Metropolitan Fire and Emergency Services Board (MFESB) as part of the Emergency Medical Response program over a seven-year period in Melbourne, Victoria, Australia.ResultsThe MFESB attended 4,450 cardiac arrests. The majority of patients presented in asystole 669 (63.7%) with just 243 (23.1%) presenting in a shockable rhythm. The majority of patients in cardiac arrest were males (64.2%) and the mean age of the patients was 67.5 years. The MFESB median response time during the study period was 5.7 minutes (IQR 2.25 minutes), range of 0.15 minutes to 31.7 minutes, which remained stable over the seven years. Patients spent a median time of 4.6 minutes (0.02 seconds to 36.5 minutes) in the care of fire fighters prior to the arrival of EMS. The rhythm on handover to paramedics was asystole in 787 (75.1%) cases with no shockable rhythms. One in three (31.3%) patients received bystander CPR, with a significant rise in the rate of bystander CPR occurring over the last two years.ConclusionThis study demonstrated acceptable response times to cardiac arrests and a low bystander CPR rate prior to arrival of the MFESB. The incidence of a shockable rhythm on arrival of the MFESB was low with the main rhythm being asystole. The main rhythm on handover to paramedics was asystole with non-shockable rhythms. Further research is required to determine the effect on patient outcomes.

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Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00800-2 ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Atsunori Tanimoto ◽

Kazuhiro Sugiyama ◽

Maki Tanabe ◽

Kanta Kitagawa ◽

Ayumi Kawakami ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Cerebral Performance Category ◽

Low Flow ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Emergency Medical Service Personnel ◽

Good Outcome ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

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Abstract 14171: Prehospital Outcomes and Patient Characteristics Associated With PulsePoint Dispatches for Out-of-Hospital Cardiac Arrest in Pittsburgh, Pennsylvania

Circulation ◽

10.1161/circ.144.suppl_2.14171 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

David Salcido ◽

Christian Martin-Gill ◽

LEONARD WEISS ◽

David D Salcido

Keyword(s):

Cardiac Arrest ◽

Response Time ◽

Statistical Significance ◽

Patient Characteristics ◽

The United States ◽

Spontaneous Circulation ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Case Characteristics ◽

Hospital Cardiac Arrest

Background: Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrest (OHCA) has been shown to increase the likelihood of early chest compressions and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists, including PulsePoint Respond, a smartphone-based volunteer dispatch system. Objective: Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint in Pittsburgh, Pennsylvania. Methods: Case data, including PulsePoint determinant triggers and timing, prehospital electronic health records (EHRs), and computer aided dispatch records were obtained for suspected EMS-treated OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS for the period July 2016 to October 2020. EHRs were reviewed to determine true OHCA status, and OHCA case characteristics were extracted according to the Utstein template. Key characteristics and the outcome of prehospital return of spontaneous circulation (ROSC) were summarized and compared between cases with and without PulsePoint dispatches. Chi-squared tests were used to determine statistical significance of relationships. Results: There were 1229 OHCA cases overall in the capture period, with an estimated 29.6% occurring in public. Of 840 total PulsePoint dispatches, 68 (8.1%) were for true OHCA. Forty-five (66.2%) of these were witnessed, 43 (63.2%) received bystander CPR, and 17 (25%) had an AED applied prior to first responder arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 34 (50%) achieved ROSC in the field. Compared to non-PulsePoint dispatch generating OHCA, PulsePoint alert-associated patients were significantly more likely to be male (p=0.024), have bystander CPR/AED application performed (p<0.001), have an initial shockable rhythm (p<0.001), and achieve ROSC (p<0.001). EMS response time, age, ALS response time, and witnessed status were not significantly different. Conclusions: A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. Among cases that did generate a PulsePoint dispatch, case characteristics were prognostically favorable.

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Abstract 364: Association Between Cardiac Arrest to Start of Extracorporeal Cardiopulmonary Resuscitation and Outcome in Patients With Out-of-Hospital Cardiac Arrest Due to Acute Coronary Syndrome

Circulation ◽

10.1161/circ.138.suppl_2.364 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Shoji Kawakami ◽

Yoshio Tahara ◽

Teruo Noguchi ◽

Shujiro Inoue ◽

Satoshi Yasuda

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cutoff Point ◽

Receiver Operating Curve ◽

Target Temperature Management ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Coronary Syndrome ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Background: The proper timing of introducing extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has yet to be well-established. Hypothesis: The interval of start of ECPR from cardiac arrest is one of predictors of short-term survival in these particularly ill patients. Methods: Between June 2014 and December 2015, we enrolled a total of 13,491 Japanese OHCA patients who were transported to hospitals in a multicenter, prospective fashion (JAAM-OHCA registry). Following exclusion criteria, 72 patients with OHCA due to ACS who were introduced ECPR until return of spontaneous circulation and underwent emergent PCI and target temperature management were eligible for this study (median 59 years-old; 95% male). We investigated the relationship between the interval of start of ECPR or successfully coronary revascularization from cardiac arrest (collapse-to-ECPR or collapse-to-PCI interval) and the survival at 30 days. Results: Patients with survival at 30 days were 50% (n=36). Age, gender, the prevalence of patients with bystander CPR or ST-elevation and collapse-to-PCI interval were comparable between patients with/without survival. The survival patients had the higher prevalence of initial shockable rhythm and the shorter collapse-to-ECPR interval than those without survival (84 vs 57%, p=0.018; 50 vs 57 min, p=0.045). Receiver operating curve analysis indicated collapse-to-ECPR interval cutoff point of 50 min (area under the curve 0.66, sensitivity 54%, specificity 75%) and collapse-to-PCI interval cutoff point of 135 min (0.65, 64%, and 67%, respectively) for predicting survival at 30 days. Multivariate logistic regression analysis revealed initial shockable rhythm and collapse-to-ECPR interval as the independent predictors of survival (OR 5.71, p=0.015; OR 1.05, p=0.025, respectively). Conclusion: Collapse-to-ECPR interval is a significantly associated with 30 days survival in patients with OHCA due to ACS, while collapse-to-PCI interval is not independent predictor of survival in this study. These findings indicate that time management for start of ECPR from cardiac arrest can be essential for improving OHCA patients’ survival.

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