Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest
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Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest. / Linde, Louise; Mørk, Sivagowry Rasalingam; Gregers, Emilie; Andreasen, Jo Bønding; Lassen, Jens Flensted; Ravn, Hanne Berg; Schmidt, Henrik; Riber, Lars Peter; Thomassen, Sisse Anette; Laugesen, Helle; Eiskjær, Hans; Terkelsen, Christian Juhl; Christensen, Steffen; Tang, Mariann; Moeller-Soerensen, Hasse; Holmvang, Lene; Kjaergaard, Jesper; Hassager, Christian; Moller, Jacob Eifer.
In: Heart, Vol. 109, 2023, p. 216-222.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest
AU - Linde, Louise
AU - Mørk, Sivagowry Rasalingam
AU - Gregers, Emilie
AU - Andreasen, Jo Bønding
AU - Lassen, Jens Flensted
AU - Ravn, Hanne Berg
AU - Schmidt, Henrik
AU - Riber, Lars Peter
AU - Thomassen, Sisse Anette
AU - Laugesen, Helle
AU - Eiskjær, Hans
AU - Terkelsen, Christian Juhl
AU - Christensen, Steffen
AU - Tang, Mariann
AU - Moeller-Soerensen, Hasse
AU - Holmvang, Lene
AU - Kjaergaard, Jesper
AU - Hassager, Christian
AU - Moller, Jacob Eifer
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023
Y1 - 2023
N2 - Objective: To describe characteristics of patients admitted with refractory cardiac arrest for possible extracorporeal cardiopulmonary resuscitation (ECPR) and gain insight into the reasons for refraining from treatment in some. Methods: Nationwide retrospective cohort study involving all tertiary centres providing ECPR in Denmark. Consecutive patients admitted with ongoing chest compression for evaluation for ECPR treatment were enrolled. Presenting characteristics, duration of no-flow and low-flow time, end-tidal carbon dioxide (ETCO2), lactate and pH, and recording of reasons for refraining from ECPR documented by the treating team were recorded. Outcomes were survival to intensive care unit admission and survival to hospital discharge. Results: Of 579 patients admitted with refractory cardiac arrest for possible ECPR, 221 patients (38%) proceeded to ECPR and 358 patients (62%) were not considered candidates. Median prehospital low-flow time was 70 min (IQR 56 to 85) in ECPR patients and 62 min (48 to 81) in no-ECPR patients, p<0.001. Intra-arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. The leading causes for not initiating ECPR stated by the treating team were duration of low-flow time in 39%, severe metabolic derangement in 35%, and in 31% low ETCO2. The prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or prehospital low-flow time combined with low ETCO2. Survival to discharge was only achieved in six patients (1.7%) in the no-ECPR group. Conclusions: In this large nationwide study of patients admitted for possible ECPR, two-thirds of patients were not treated with ECPR. The most frequent reasons to abstain from ECPR were long duration of prehospital low-flow time, metabolic derangement and low ETCO2.
AB - Objective: To describe characteristics of patients admitted with refractory cardiac arrest for possible extracorporeal cardiopulmonary resuscitation (ECPR) and gain insight into the reasons for refraining from treatment in some. Methods: Nationwide retrospective cohort study involving all tertiary centres providing ECPR in Denmark. Consecutive patients admitted with ongoing chest compression for evaluation for ECPR treatment were enrolled. Presenting characteristics, duration of no-flow and low-flow time, end-tidal carbon dioxide (ETCO2), lactate and pH, and recording of reasons for refraining from ECPR documented by the treating team were recorded. Outcomes were survival to intensive care unit admission and survival to hospital discharge. Results: Of 579 patients admitted with refractory cardiac arrest for possible ECPR, 221 patients (38%) proceeded to ECPR and 358 patients (62%) were not considered candidates. Median prehospital low-flow time was 70 min (IQR 56 to 85) in ECPR patients and 62 min (48 to 81) in no-ECPR patients, p<0.001. Intra-arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. The leading causes for not initiating ECPR stated by the treating team were duration of low-flow time in 39%, severe metabolic derangement in 35%, and in 31% low ETCO2. The prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or prehospital low-flow time combined with low ETCO2. Survival to discharge was only achieved in six patients (1.7%) in the no-ECPR group. Conclusions: In this large nationwide study of patients admitted for possible ECPR, two-thirds of patients were not treated with ECPR. The most frequent reasons to abstain from ECPR were long duration of prehospital low-flow time, metabolic derangement and low ETCO2.
KW - EMERGENCY MEDICINE
KW - Ethics, Medical
KW - Heart-Assist Devices
U2 - 10.1136/heartjnl-2022-321405
DO - 10.1136/heartjnl-2022-321405
M3 - Journal article
C2 - 36371665
AN - SCOPUS:85138641183
VL - 109
SP - 216
EP - 222
JO - Heart
JF - Heart
SN - 1355-6037
ER -
ID: 329286360