Abstract 171: Developing an ECPR Program for Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Meshe Chonde ◽  
Jeremiah Escajeda ◽  
Jonathan Elmer ◽  
Arthur Boujoukos ◽  
Penny L Sappington ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Coronary Intervention ◽  
Quality Improvement Initiative ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Catheterization Laboratory ◽  
Program Selection ◽  
Alternative Means ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a novel treatment for cardiac arrest that is refractory to conventional cardiopulmonary resuscitation (CPR). As part of a quality improvement initiative we sought to develop a program at our institution. Hypothesis: ECPR is a feasible and effective alternative means of resuscitation for patients in refractory cardiac arrest. Methods: We developed a multidisciplinary ECPR team consisting of staff from Emergency Medical Services (EMS), Emergency Department, Cardiology, Cardiac Surgery and Critical Care Medicine. Patients with an out of hospital cardiac arrest (OHCA) refractory to medical treatment were identified by EMS and brought to our institution if they met our program selection criteria. The patient was cannulated in the Emergency Department or Catheterization Laboratory, then underwent coronary angiogram with intervention if applicable and was transferred to cardiothoracic intensive care unit (ICU) for further care. Results: From October 1 st 2015 to March 31 st 2018, a total of 1165 out of hospital cardiac arrests occurred, of which five met criteria for our study. Median age was 47 [IQR 32-53] and four were men. Most common arrest rhythm was VF (80%), one patient had ST elevation on EKG. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min with 5 [IQR 3-6] defibrillations and 6 [IQR 6-7] doses of epinephrine administered. Four patients were successfully cannulated (80%). Cannulation time was 21 [IQR 16-33] min, with one patient achieving ROSC during cannulation. All patients underwent angiography, with two patients receiving coronary intervention (40%). ECMO duration was 48 [IQR 38-68] hours and length of stay was 2 [IQR 2-8] days. All patients had an initial Pittsburgh Cardiac Arrest Category of 4. Two patients (40%) survived to hospital discharge with good neurologic function. Conclusions: ECPR is a potentially life-saving alternative treatment to conventional CPR that is feasible in our patient population.

Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

2021 ◽  
pp. 1-10
Author(s):  
Christopher Gaisendrees ◽  
Matias Vollmer ◽  
Sebastian G Walter ◽  
Ilija Djordjevic ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Abstract P85: Out-of-hospital Cardiac Arrests With Extracorporeal Cardiopulmonary Resuscitation In Japan: Systematic Literature Review

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tetsuya Sakamoto ◽  
Yasufumi Asai ◽  
Ken Nagao ◽  
Yoshio Tahara ◽  
Takahiro Atsumi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Literature Review ◽  
Case Series ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Funnel Plot ◽  
Case Series Study ◽  
Series Study ◽  
Hospital Cardiac Arrest

Background: In Japan, extracorporeal cardiopulmonary resuscitation (ECPR) became popular for cardiac arrest patients who resist conventional advanced life supports. Regardless of many clinical experiences, there has been no previous systematic literature review. Methods: Case series, reports and proceedings of scientific meeting about ECPR for out-of-hospital cardiac arrest written in Japanese between January 1, 1983 and July 31, 2007 were collected with Japana Centra Revuo Medicina (medical publication database in Japan) and review by experts. The outcome and characteristics of the patients were investigated, and the influence of publication bias of the case series study was also examined by the Funnel Plot method. Results: There were 951 out-of-hospital cardiac arrest patients who received ECPR in 92 reports (including 59 case series and 33 case reports) during the period. The average of age was 38.1 (4 – 88) years old and 76.1% was male. Three hundreds and eighty-one cases (40.1%) were arrests of cardiac etiology, and 212 were non-cardiac (22.3%). The cause of arrest was not described in other 37.6%. Excluding reports for only one case, weighted survival rate at discharge of 792 cases those were clearly described the outcome was 39.5±10.0%. When the relationship between the number of cases and the survival rate at discharge in each 59 case series study was shown in figure by the Funnel Plot method, the plotted data presented the reverse-funnel type that centered on the average of survival rate of all. Conclusions: The influence of publication bias of previous reports in Japan was relatively low. ECPR can greatly contribute to improve the outcome of out-of hospital cardiac arrests.

scholarly journals In-hospital extracorporeal cardiopulmonary resuscitation (ECPR) after prolonged out-of-hospital cardiac arrest (OHCA). A case report

Resuscitation ◽  
2018 ◽  
Vol 130 ◽  
pp. e48-e49
Author(s):  
Antonella Vezzani ◽  
Tullio Manca ◽  
Andrea Ramelli ◽  
Bruno Borrello ◽  
Andrea Agostinelli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

scholarly journals Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yo Sep Shin ◽  
Youn-Jung Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
Shin Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Status ◽  
Good Neurologic Outcome ◽  
Hospital Stays ◽  
Hospital Cardiac Arrest

AbstractPrecise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

Sign in / Sign up

Export Citation Format

Share Document