A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest,Resuscitation

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A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest
Resuscitation ( IF 6.5 ) Pub Date : 2021-08-09 , DOI: 10.1016/j.resuscitation.2021.08.004
Brian Grunau ₁ , Jamil Bashir ₂ , Anson Cheung ₂ , Robert Boone ₃ , Ken McDonald ₄ , Frank Scheuermeyer ₅ , Joel Singer ₆ , Sandra Jenneson ₇ , Ron Straight ₈ , Brian Twaites ₈ , Luke Harris ₂ , Scott Haig ₈ , Devin Harris ₉ , Richard Vandegriend ₁₀ , Hussein Kanji ₁₁ , Jim Christenson ₅

Affiliation

St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada.
St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada.
St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiology, University of British Columbia, Canada.
St. Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada.
St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada.
Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada.
Department of Emergency Medicine, University of British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Royal Columbian Hospital, New Westminster, B.C., Canada.
British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada.
Department of Emergency Medicine, University of British Columbia, Canada; Kelowna General Hospital, Kelowna, B.C., Canada.
Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada.
Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada; Vancouver General Hospital, Vancouver, B.C., Canada.

Objectives

Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system.

Methods

We introduced a prehospital-activated ECPR protocol for select refractory OHCAs into one of four metropolitan regions in British Columbia. We prospectively identified ECPR-eligible patients in both the ECPR region and the three other regions to serve as the control group. We compared the proportion with favorable neurological outcomes at hospital discharge (cerebral performance category $\leq$ 2) and used logistic regression to estimate the association with treatment region.

Results

The study was terminated prematurely due to changes in hospital protocols and COVID-19. In the ECPR region, 15/58 (25.9%) patients had favourable neurological outcomes owing to conventional resuscitation and 2/58 (3.4%) owing to ECPR, for a total of 17/58 (29.3%). In the control regions, 67/250 (26.8%) patients had a favourable outcome owing to conventional resuscitation, for a between-group difference of 2.5% (95% CI −10 to 15%). We did not detect a statistically significant association between treatment region and outcomes.

Conclusion

In this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies.

中文翻译：

一项针对难治性院外心脏骤停的院前激活 ECPR 方案的实用平行组实施研究

目标

心肺复苏术 (ECPR) 中的体外膜肺氧合可以提高难治性院外心脏骤停 (OHCA) 患者的生存率。我们评估了将 ECPR 纳入传统复苏系统后的结果。

方法

我们在不列颠哥伦比亚省的四个大都市区之一引入了院前激活的 ECPR 协议，用于选择难治性 OHCA。我们前瞻性地确定了 ECPR 区域和其他三个区域中符合 ECPR 条件的患者作为对照组。我们比较了出院时神经功能良好的比例（脑功能类别 $\leq$ 2）并使用逻辑回归来估计与治疗区域的关联。

结果

由于医院协议和 COVID-19 的变化，该研究提前终止。在 ECPR 地区，15/58 (25.9%) 的患者因常规复苏而获得良好的神经学结果，2/58 (3.4%) 的患者因 ECPR 而获得良好的神经学结果，总计 17/58 (29.3%)。在对照组中，67/250 (26.8%) 的患者由于常规复苏获得了良好的结果，组间差异为 2.5%（95% CI -10 至 15%）。我们没有发现治疗区域和结果之间存在统计学上的显着关联。