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Exploratory analysis on the need for an ECMO eCPR service in South East London

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Exploratory analysis on the need for an ECMO eCPR service in South East London

 

Author(s):

 

T. Hurst2, J. Nevett4, M. Whitbread4, G. Virdi4, S. Picton4,  R. Loveridge1, S. Patel1, E. Gelandt1, L. Morgan1, S. Butt3, M. Whitehorne3, C. Willars1, V. Kakar2, C. Park2, T. Best2, A. Vercueil2, G. Auzinger1

 

Institute(s):

 

1Department of Liver Intensive and General Critical Care, King's College Hospital, London, United Kingdom, 2Department of General Critical Care, King's College Hospital, London, United Kingdom, 3Department of Cardiac Perfusion science, King’s College Hospital, London, 4London Ambulance Service


 

 

Survival after refractory cardiac arrest is poor and ECMO (eCPR) has been demonstrated to be superior to conventional CPR in patients suffering refractory cardiac arrest.1

 

King’s College Hospital is a major acute emergency, tertiary and cardiac arrest centre which receives such patients and an ECMO service is available on site providing a comprehensive ECLS programme with excellent outcomes.2,3

 

eCPR has been undertaken for a number of in and out of hospital arrests – survival in those with true eCPR is 43 % (n = 21), and 50 % in those with either true eCPR, an OHCA at presentation, or when ECMO was initiated in ED for those with transient ROSC only (n = 28).

 

We sought to establish the need for a more formal service to be developed as many patients with refractory cardiac arrest are not transported to hospital, but rather they undergo full ALS in the community supported by a tiered ambulance service response.

 

Methods:

 

A retrospective analysis of was undertaken for patients who met the following criteria in 2015-16 by the London Ambulance Service:

 

  • Age 16-65
  • Bystander CPR but no ROSC at 20 minutes
  • Within a 20 minute drive time of King’s College Hospital
  • Monday to Friday 08:00-18:00
  • Emergency calls allocated the highest priority response from the ambulance service

 

Patients suffering traumatic cardiac arrest were excluded.

 

Both patients transported to King’s with CPR ongoing, and those where paramedics discontinued resuscitation and undertook a “recognition of life extinct” protocol, were included.

 

Results:

 

In one year, 58 patients matching the search criteria above were identified.

 

There were 21 patients (median age 53, range 24 - 62) conveyed to hospital with a median scene time of 46 minutes and 37 patients (median age 49, range 19 – 65) not transported – 72 % were presumed cardiac in origin.

 

Conclusion:

 

There is potentially a significant unmet need for eCPR in refractory cardiac arrest with young patients dying in the pre-hospital phase and, based on survival statistics in the ELSO registry data (29 % survival to discharge), there could be an additional 15 survivors per year within a 20 minute drive time of King’s College Hospital within the working week.

 

There should be a nationally led assessment of the need for eCPR within the UK and support for local providers innovating in this area.

 

 

References:

 

  1. Stub et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation 2015; 86: 88-94
  2. Loveridge et al. The SAVE SMR for veno-arterial ECMO? Critical Care 2016 20(suppl 2): 108
  1. Auzinger et al. Acute liver failure and ECMO support: The edge of reason? Hepatology 2015 62(suppl 1): 1073

 

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