A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest
Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system. We introduced a prehospital-activated ECPR protocol for select ref...
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| Published in: | Resuscitation Vol. 167; pp. 22 - 28 |
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| Main Authors: | , , , , , , , , , , , , , , , |
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Elsevier B.V
01-10-2021
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| Abstract | Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system.
We introduced a prehospital-activated ECPR protocol for select refractory OHCAs into one of four metropolitan regions in British Columbia. We prospectively identified ECPR-eligible patients in both the ECPR region and the three other regions to serve as the control group. We compared the proportion with favorable neurological outcomes at hospital discharge (cerebral performance category ≤2) and used logistic regression to estimate the association with treatment region.
The study was terminated prematurely due to changes in hospital protocols and COVID-19. In the ECPR region, 15/58 (25.9%) patients had favourable neurological outcomes owing to conventional resuscitation and 2/58 (3.4%) owing to ECPR, for a total of 17/58 (29.3%). In the control regions, 67/250 (26.8%) patients had a favourable outcome owing to conventional resuscitation, for a between-group difference of 2.5% (95% CI −10 to 15%). We did not detect a statistically significant association between treatment region and outcomes.
In this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies. |
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| AbstractList | OBJECTIVESExtracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system. METHODSWe introduced a prehospital-activated ECPR protocol for select refractory OHCAs into one of four metropolitan regions in British Columbia. We prospectively identified ECPR-eligible patients in both the ECPR region and the three other regions to serve as the control group. We compared the proportion with favorable neurological outcomes at hospital discharge (cerebral performance category ≤2) and used logistic regression to estimate the association with treatment region. RESULTSThe study was terminated prematurely due to changes in hospital protocols and COVID-19. In the ECPR region, 15/58 (25.9%) patients had favourable neurological outcomes owing to conventional resuscitation and 2/58 (3.4%) owing to ECPR, for a total of 17/58 (29.3%). In the control regions, 67/250 (26.8%) patients had a favourable outcome owing to conventional resuscitation, for a between-group difference of 2.5% (95% CI -10 to 15%). We did not detect a statistically significant association between treatment region and outcomes. CONCLUSIONIn this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies. Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system. We introduced a prehospital-activated ECPR protocol for select refractory OHCAs into one of four metropolitan regions in British Columbia. We prospectively identified ECPR-eligible patients in both the ECPR region and the three other regions to serve as the control group. We compared the proportion with favorable neurological outcomes at hospital discharge (cerebral performance category ≤2) and used logistic regression to estimate the association with treatment region. The study was terminated prematurely due to changes in hospital protocols and COVID-19. In the ECPR region, 15/58 (25.9%) patients had favourable neurological outcomes owing to conventional resuscitation and 2/58 (3.4%) owing to ECPR, for a total of 17/58 (29.3%). In the control regions, 67/250 (26.8%) patients had a favourable outcome owing to conventional resuscitation, for a between-group difference of 2.5% (95% CI −10 to 15%). We did not detect a statistically significant association between treatment region and outcomes. In this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies. |
| Author | Jenneson, Sandra Christenson, Jim Straight, Ron Twaites, Brian Bashir, Jamil Singer, Joel Scheuermeyer, Frank Harris, Luke Haig, Scott Harris, Devin Vandegriend, Richard Kanji, Hussein Cheung, Anson Boone, Robert Grunau, Brian McDonald, Ken |
| Author_xml | – sequence: 1 givenname: Brian orcidid: 0000-0003-4103-1383 surname: Grunau fullname: Grunau, Brian email: Brian.Grunau@ubc.ca organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 2 givenname: Jamil surname: Bashir fullname: Bashir, Jamil organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 3 givenname: Anson orcidid: 0000-0003-1466-2788 surname: Cheung fullname: Cheung, Anson organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 4 givenname: Robert surname: Boone fullname: Boone, Robert organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 5 givenname: Ken surname: McDonald fullname: McDonald, Ken organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 6 givenname: Frank surname: Scheuermeyer fullname: Scheuermeyer, Frank organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 7 givenname: Joel orcidid: 0000-0002-7220-4382 surname: Singer fullname: Singer, Joel organization: Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada – sequence: 8 givenname: Sandra surname: Jenneson fullname: Jenneson, Sandra organization: Department of Emergency Medicine, University of British Columbia, Canada – sequence: 9 givenname: Ron surname: Straight fullname: Straight, Ron organization: British Columbia Emergency Health Services, British Columbia, Canada – sequence: 10 givenname: Brian surname: Twaites fullname: Twaites, Brian organization: British Columbia Emergency Health Services, British Columbia, Canada – sequence: 11 givenname: Luke surname: Harris fullname: Harris, Luke organization: St. Paul’s Hospital, Vancouver, BC, Canada – sequence: 12 givenname: Scott surname: Haig fullname: Haig, Scott organization: British Columbia Emergency Health Services, British Columbia, Canada – sequence: 13 givenname: Devin surname: Harris fullname: Harris, Devin organization: Department of Emergency Medicine, University of British Columbia, Canada – sequence: 14 givenname: Richard orcidid: 0000-0001-9739-850X surname: Vandegriend fullname: Vandegriend, Richard organization: Royal Columbian Hospital, New Westminster, B.C., Canada – sequence: 15 givenname: Hussein surname: Kanji fullname: Kanji, Hussein organization: Royal Columbian Hospital, New Westminster, B.C., Canada – sequence: 16 givenname: Jim orcidid: 0000-0001-7126-6314 surname: Christenson fullname: Christenson, Jim organization: St. Paul’s Hospital, Vancouver, BC, Canada |
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| Snippet | Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated... OBJECTIVESExtracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We... |
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| SubjectTerms | Extracorporeal membrane oxygenation Heart arrest Out-of-hospital cardiac arrest |
| Title | A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest |
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