Cardiac arrest & resuscitation
Prehospital initiation of extracorporeal life support for refractory out-of-hospital cardiac arrest–results of a prospective observational study
Authors' conclusion
Prehospital ECPR is feasible and can be integrated into a regional emergency medical system when performed by a highly experienced team. Survival rates in this selected cohort exceeded typical OHCA outcomes, with a high proportion of patients achieving favorable neurological recovery. Early VA ECMO initiation and several on-scene factors are key determinants of prognosis.
Study context
- Population
- Patients with refractory out-of-hospital cardiac arrest (OHCA), Regensburg, Germany, October 2013 to September 20232,655 on-scene evaluations
- Participants
- 213 patients
- Outcome
- Hospital discharge rate and neurological function
Methodological detailssingle-region, prehospital extracorporeal CPR (ECPR) programme
- Single-region
- Prehospital ECPR programme
Main finding
As reported in the abstract
Survival to hospital discharge after on-scene VA ECMO
34.7%
74/213
Observational data: associations, not effects.
Further findings
On-scene predictors of unfavorable outcome (multivariable analysis)
| OR (CI) | P value | ||
|---|---|---|---|
| Bilaterally dilated pupilsMultivariable analysis restricted to on-scene variables | 5.79 (1.85–19.8) | P = 0.003 | |
| Absence of bystander CPRMultivariable analysis restricted to on-scene variables | 4.38 (1.23–18.2) | P = 0.029 | |
| Mechanical CPR devicesMultivariable analysis restricted to on-scene variables | 5.53 (2.09–15.9) | P < 0.001 | |
| Initial asystoleMultivariable analysis restricted to on-scene variables | 35.0 (5.24–731) | P = 0.002 | |
| CPR-to-ECMO interval > 45 minMultivariable analysis restricted to on-scene variables | 3.07 (1.09–9.14) | P = 0.037 | |
| 0.050.21520Odds ratio (log scale) |
Time from beginning of cardiopulmonary resuscitation (CPR) to start of VA ECMO
- Median CPR-to-VA ECMO time
- 45 min (IQR: 35-63)
ECMO duration
- Median ECMO duration
- 2 days (IQR 1-4)
Good neurological outcome and independent daily living among survivors
- Survivors with good neurological outcome and independent daily living
- 89.2% (66/74)
Original publication
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