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Original research
Hospital-administered ECPR for out-of-hospital cardiac arrest: an observational cohort study
  1. Tuukka Puolakka1,
  2. Ari Salo1,
  3. Marjut Varpula2,
  4. Jouni Nurmi1,
  5. Markus B Skrifvars1,3,
  6. Erika Wilkman4,
  7. Karl Lemström3,5,
  8. Markku Kuisma1
  1. 1 Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
  2. 2 Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
  3. 3 Faculty of Medicine, University of Helsinki, Helsinki, Finland
  4. 4 Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
  5. 5 Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
  1. Correspondence to Dr Tuukka Puolakka, Department of Emergency Medicine and Services, HUS Helsinki University Hospital, P.O. Box 112, FI-00999 Helsinki, Finland; tuukka.puolakka{at}hus.fi

Abstract

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment method for refractory out-of-hospital cardiac arrest (OHCA) requiring a complex chain of care.

Methods All cases of OHCA between 1 January 2016 and 31 December 2021 in the Helsinki University Hospital catchment area in which the ECPR protocol was activated were included in the study. The protocol involved patient transport from the emergency site with ongoing mechanical cardiopulmonary resuscitation (CPR) directly to the cardiac catheterisation laboratory where the implementation of extracorporeal membrane oxygenation (ECMO) was considered. Cases of hypothermic cardiac arrest were excluded. The main outcomes were the number of ECPR protocol activations, duration of prehospital and in-hospital time intervals, and whether the ECPR candidates were treated using ECMO or not.

Results The prehospital ECPR protocol was activated in 73 cases of normothermic OHCA. The mean patient age (SD) was 54 (±11) years and 67 (91.8%) of them were male. The arrest was witnessed in 67 (91.8%) and initial rhythm was shockable in 61 (83.6%) cases. The median ambulance response time (IQR) was 9 (7–11) min. All patients received mechanical CPR, epinephrine and/or amiodarone. Seventy (95.9%) patients were endotracheally intubated. The median (IQR) highest prehospital end-tidal CO2 was 5.5 (4.0–6.9) kPa.

A total of 37 (50.7%) patients were treated with venoarterial ECMO within a median (IQR) of 84 (71–105) min after the arrest. Thirteen (35.1%) of them survived to discharge and 11 (29.7%) with a cerebral performance category (CPC) 1–2. In those ECPR candidates who did not receive ECMO, 8 (22.2%) received permanent return of spontaneuous circulation during transport or immediately after hospital arrival and 6 (16.7%) survived to discharge with a CPC 1–2.

Conclusions Half of the ECPR protocol activations did not lead to ECMO treatment. However, every fourth ECPR candidate and every third patient who received ECMO-facilitated resuscitation at the hospital survived with a good neurological outcome.

  • heart arrest
  • emergency ambulance systems
  • acute coronary syndrome
  • doctors in PHC

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

https://doi.org/10.1136/emermed-2023-213292

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    Data availability statement

    Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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    Footnotes

    • Handling editor Darryl Wood

    • Presented at Presented in part at the London Trauma Conference in London, UK, 6–9 December 2022.

    • Contributors TP, AS, MV, JN, EW, KL and MK researched literature and conceived the study. TP, AS, JN and MV collected the study data. TP and AS were responsible for statistical analysis. TP, AS, MV, MBS and MK interpreted the results. TP wrote the first draft of the manuscript. All authors reviewed and edited the manuscript for important intellectual content and approved the final version. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MK acted as the guarantor of the study.

    • Funding This study was supported by the Helsinki University Hospital (VTR-funding), the Laerdal Foundation for Acute Medicine (3624) (TP) and Viipurin tuberkuloosisäätiö (n/a) (TP).

    • Competing interests MBS reports speakers fees from BARD Medical (Ireland). Other authors report no competing interests.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.