Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial)

Dion Ashley Stub, Stephen Anthony Bernard, Vincent Pellegrino, Karen Louise Smith, Tony Walker, Jayne Sheldrake, Lisen Emma Hockings, James Shaw, Stephen Duffy, Aidan John Cobb Burrell, Peter Cameron, Devilliers Smit, David M Kaye

Research output: Contribution to journalArticleResearchpeer-review

261 Citations (Scopus)

Abstract

NTRODUCTION: Many patients who suffer cardiac arrest do not respond to standard cardiopulmonary resuscitation. There is growing interest in utilizing veno-arterial extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) in the management of refractory cardiac arrest. We describe our preliminary experiences in establishing an E-CPR program for refractory cardiac arrest in Melbourne, Australia. METHODS: The CHEER trial (mechanical CPR, Hypothermia, ECMO and Early Reperfusion) is a single center, prospective, observational study conducted at The Alfred Hospital. The CHEER protocol was developed for selected patients with refractory in-hospital and out-of-hospital cardiac arrest and involves mechanical CPR, rapid intravenous administration of 30mL/kg of ice-cold saline to induce intra-arrest therapeutic hypothermia, percutaneous cannulation of the femoral artery and vein by two critical care physicians and commencement of veno-arterial ECMO. Subsequently, patients with suspected coronary artery occlusion are transferred to the cardiac catheterization laboratory for coronary angiography. Therapeutic hypothermia (33?C) is maintained for 24h in the intensive care unit. RESULTS: There were 26 patients eligible for the CHEER protocol (11 with OHCA, 15 with IHCA). The median age was 52 (IQR 38-60) years. ECMO was established in 24 (92 ), with a median time from collapse until initiation of ECMO of 56 (IQR 40-85) min. Percutaneous coronary intervention was performed on 11 (42 ) and pulmonary embolectomy on 1 patient. Return of spontaneous circulation was achieved in 25 (96 ) patients. Median duration of ECMO support was 2 (IQR 1-5) days, with 13/24 (54 ) of patients successfully weaned from ECMO support. Survival to hospital discharge with full neurological recovery (CPC score 1) occurred in 14/26 (54 ) patients. CONCLUSIONS: A protocol including E-CPR instituted by critical care physicians for refractory cardiac arrest which includes mechanic
Original languageEnglish
Pages (from-to)88 - 94
Number of pages7
JournalResuscitation
Volume86
DOIs
Publication statusPublished - 2015

Cite this