Potential candidates for a structured Canadian ECPR program for out-of-hospital cardiac arrest

Brian Grunau, Frank Xavier Scheuermeyer, Dion Stub, Robert H. Boone, Joseph Finkler, Sarah Pennington, Sarah Ann Carriere, Anson Cheung, Ruth Macredmond, Jamil Bashir, Jim Christenson

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18 Citations (Scopus)

Abstract

Objective: Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. Methods: We performed a secondary analysis from a 52-month prospective registry of consecutive adult nontraumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge. Results: Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge. Conclusion: In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.

Original languageEnglish
Pages (from-to)453-460
Number of pages8
JournalCanadian Journal of Emergency Medicine
Volume18
Issue number6
DOIs
Publication statusPublished - Nov 2016
Externally publishedYes

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • ECMO
  • ECPR

Cite this

Grunau, B., Scheuermeyer, F. X., Stub, D., Boone, R. H., Finkler, J., Pennington, S., Carriere, S. A., Cheung, A., Macredmond, R., Bashir, J., & Christenson, J. (2016). Potential candidates for a structured Canadian ECPR program for out-of-hospital cardiac arrest. Canadian Journal of Emergency Medicine, 18(6), 453-460. https://doi.org/10.1017/cem.2016.8