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Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres

Objective: To compare the outcomes of patients with refractory out-of-hospital cardiac arrest (OHCA) transported to a hospital that provides extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) with patients transported to hospitals without ECPR capability. Design,...

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Autores principales: Bernard, Stephen A., Hopkins, Sarah J., Ball, Jocasta C., Stub, Dion A., Stephenson, Michael W., Nanjayya, Vinodh B., Pellegrino, Vincent A., Sheldrake, Jayne, Richardson, Alexander C., Smith, Karen L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692645/
https://www.ncbi.nlm.nih.gov/pubmed/38046837
http://dx.doi.org/10.51893/2022.1.OA1
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author Bernard, Stephen A.
Hopkins, Sarah J.
Ball, Jocasta C.
Stub, Dion A.
Stephenson, Michael W.
Nanjayya, Vinodh B.
Pellegrino, Vincent A.
Sheldrake, Jayne
Richardson, Alexander C.
Smith, Karen L.
author_facet Bernard, Stephen A.
Hopkins, Sarah J.
Ball, Jocasta C.
Stub, Dion A.
Stephenson, Michael W.
Nanjayya, Vinodh B.
Pellegrino, Vincent A.
Sheldrake, Jayne
Richardson, Alexander C.
Smith, Karen L.
author_sort Bernard, Stephen A.
collection PubMed
description Objective: To compare the outcomes of patients with refractory out-of-hospital cardiac arrest (OHCA) transported to a hospital that provides extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) with patients transported to hospitals without ECPR capability. Design, setting: Retrospective review of patient care records in a pre-hospital and hospital setting. Participants: Adult patients with OHCA who left the scene and arrived with cardiopulmonary resuscitation in progress at 16 hospitals in Melbourne, Australia, between January 2016 and December 2019. Intervention: For selected patients transported to the ECPR centre, initiation of ECMO. Main outcome measures: Survival to hospital discharge and 12-month quality of life. Results: There were 223 eligible patients during the study period. Of 49 patients transported to the ECPR centre, 23 were commenced on ECMO. Of these, survival to hospital with good neurological recovery (Cerebral Performance Category [CPC] score 1/2) occurred in 4/23 patients. Four other patients developed return of spontaneous circulation in the ECPR centre before cannulation of whom one survived, giving overall good functional outcome at 12 months survival of 5/49 (10.2%). There were 174 patients transported to the 15 non-ECPR centres and 3/174 (2%) had good functional outcome at 12 months. After adjustment for baseline differences, the odds ratio for good neurological outcome after transport to an ECPR centre compared with a non-ECPR centre was 4.63 (95% CI, 0.97–22.11; P = 0.055). Conclusion: The survival rate of patients with refractory OHCA transported to an ECPR centre remains low. Outcomes in larger cities might be improved with shorter scene times and additional ECPR centres that would provide for earlier initiation of ECMO.
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spelling pubmed-106926452023-12-03 Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres Bernard, Stephen A. Hopkins, Sarah J. Ball, Jocasta C. Stub, Dion A. Stephenson, Michael W. Nanjayya, Vinodh B. Pellegrino, Vincent A. Sheldrake, Jayne Richardson, Alexander C. Smith, Karen L. Crit Care Resusc Original Articles Objective: To compare the outcomes of patients with refractory out-of-hospital cardiac arrest (OHCA) transported to a hospital that provides extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) with patients transported to hospitals without ECPR capability. Design, setting: Retrospective review of patient care records in a pre-hospital and hospital setting. Participants: Adult patients with OHCA who left the scene and arrived with cardiopulmonary resuscitation in progress at 16 hospitals in Melbourne, Australia, between January 2016 and December 2019. Intervention: For selected patients transported to the ECPR centre, initiation of ECMO. Main outcome measures: Survival to hospital discharge and 12-month quality of life. Results: There were 223 eligible patients during the study period. Of 49 patients transported to the ECPR centre, 23 were commenced on ECMO. Of these, survival to hospital with good neurological recovery (Cerebral Performance Category [CPC] score 1/2) occurred in 4/23 patients. Four other patients developed return of spontaneous circulation in the ECPR centre before cannulation of whom one survived, giving overall good functional outcome at 12 months survival of 5/49 (10.2%). There were 174 patients transported to the 15 non-ECPR centres and 3/174 (2%) had good functional outcome at 12 months. After adjustment for baseline differences, the odds ratio for good neurological outcome after transport to an ECPR centre compared with a non-ECPR centre was 4.63 (95% CI, 0.97–22.11; P = 0.055). Conclusion: The survival rate of patients with refractory OHCA transported to an ECPR centre remains low. Outcomes in larger cities might be improved with shorter scene times and additional ECPR centres that would provide for earlier initiation of ECMO. Elsevier 2023-10-18 /pmc/articles/PMC10692645/ /pubmed/38046837 http://dx.doi.org/10.51893/2022.1.OA1 Text en © 2022 College of Intensive Care Medicine of Australia and New Zealand. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Articles
Bernard, Stephen A.
Hopkins, Sarah J.
Ball, Jocasta C.
Stub, Dion A.
Stephenson, Michael W.
Nanjayya, Vinodh B.
Pellegrino, Vincent A.
Sheldrake, Jayne
Richardson, Alexander C.
Smith, Karen L.
Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres
title Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres
title_full Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres
title_fullStr Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres
title_full_unstemmed Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres
title_short Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres
title_sort outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ecmo centre compared with transport to non-ecmo centres
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692645/
https://www.ncbi.nlm.nih.gov/pubmed/38046837
http://dx.doi.org/10.51893/2022.1.OA1
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