Extracorporeal cardiopulmonary resuscitation (eCPR) for out-of-hospital cardiac arrest (OHCA) Retrospective analysis of a load and go strategy under the aspect of golden hour of eCPR
- 1 May 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Der Anaesthesist
- Vol. 70 (5), 376-382
- https://doi.org/10.1007/s00101-020-00896-2
Abstract
Background Survival rates after an out-of-hospital cardiac arrest (OHCA) remain low. Extracorporeal cardiopulmonary resuscitation (eCPR) has been introduced as an attempt to increase survival in selected patients and observational studies have shown promising results. Nevertheless, inclusion criteria and timing of eCPR remain undefined. Objective The current study analyzed a load and go strategy with respect to the golden hour of eCPR as a cut-off time for survival and favorable neurological outcome. Material and methods This retrospective cohort study included 32 patients who underwent eCPR treatment due to an OHCA between January 2017 and September 2019. Routinely taken patient demographic data (age, BMI, sex) were analyzed. The main focus was set on processing times in the preclinical and clinical setting. Time intervals including OHCA until ambulance arrival, time on scene, transportation times and door to eCPR were extracted from emergency medical service (EMS) and resuscitation protocols. Low-flow times, survival and neurological outcome were analyzed. Results The use of eCPR in OHCA was associated with survival to hospital discharge in 28% and a good neurological outcome in 19% of the cases. Both groups (survivor and nonsurvivor) did not differ in patient demographics except for age. Survivors were significantly younger (47 (30-60) vs. 59 (50-68) years, p = 0.035). Processing times as well as low-flow times were not significantly different (OHCA-eCPR survivor 64 (50-87) vs. non-survivor 74 (51-85) min; p-value 0.64); however, median low-flow times were outside the golden hour of eCPR (69 (52-86)). Conclusion Despite low-flow times of more than 60 min, eCPR was associated with survival in 28% after OHCA. Hence, exceeding the golden hour of eCPR cannot act as a definitive exclusion criterion for eCPR.Keywords
This publication has 25 references indexed in Scilit:
- Neuroprotective strategies and neuroprognostication after cardiac arrestBest Practice & Research Clinical Anaesthesiology, 2015
- European Resuscitation Council Guidelines for Resuscitation 2015Resuscitation, 2015
- Recent Trends in Survival From Out-of-Hospital Cardiac Arrest in the United StatesCirculation, 2014
- High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survivalNetherlands Heart Journal, 2014
- An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched studyCritical Care, 2014
- Post-resuscitation care for survivors of cardiac arrestIndian Heart Journal, 2014
- Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac ArrestCirculation, 2013
- Extracorporeal cardiopulmonary resuscitation for adult cardiac arrest patientsWorld Journal of Critical Care Medicine, 2012
- Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studiesResuscitation, 2010
- Compression of the Left Ventricular Outflow Tract During Cardiopulmonary ResuscitationAcademic Emergency Medicine, 2009