Short summary

Since 2015 the Region of Southern Denmark has offered treatment for refractory cardiac arrest at Odense University Hospital. The treatment offered to a selected group of patients is extracorporeal cardiopulmonary resuscitation (eCPR). Within eCPR patients receives mechanical circulatory support. This project is a retrospective study evaluating all patients received for possible eCPR at OUH from 2015-2020. The primary focus is to evaluate the exclusion criteria and characteristics and outcomes of patients treated with eCPR.

Rationale

The survival of patients with out-of-hospital cardiac arrest (OHCA) is critically associated with the initial rhythm the patient present with to emergency medical services (EMS). An initial shockable rhythm is associated with better survival compared to patients presenting with non-shockable rhythm. Even with a favorable presenting rhythm, many patients never achieve return of spontaneous circulation (ROSC) and life support is terminated at the scene of cardiac arrest. Generally resuscitation is continued for 30 to 45 min before considered futile.

Initial case reports of successful resuscitation with favorable outcome in selected patients using mechanical circulatory support with extracorporeal life support despite prolonged resuscitation, has led to the concept of extracorporeal cardiopulmonary resuscitation (eCPR). ECPR can be considered a rescue attempt for selected patients with refractory cardiac arrest of potentially reversible cause (e.g. myocardial infarction or primary arrhythmia). Depending on selection criteria survival rates of less than 10% up to more than 40% have been reported for eCPR case series. Some of the pioneers within the field of eCPR at the Service d'AideMédicale Urgente of Paris recently demonstrated that introduction of an eCPR strategy with rigorous patient selection and protocolled management strategy, could improve survival from 8% to more than 30%. Most eCPR protocols base the patient selection criteria on whether cardiac arrest was witnessed, whether there was immediate bystander life support, whether initial rhythm was shockable, estimation of quality of chest compression based on end-tidal CO2 measurements, age of the patient and comorbidity. Many of these observations are not dichotomous and not straight forward in an emergency situation as cardiac arrest. No previous observational studies with well-defined eCPR protocols have reported the number of patients evaluated for eCPR eventually turned down for active treatment and reasons for not initiating eCPR.

The objective of this study is to evaluate the experience with eCPR in the Region of Southern Denmark during a 5 year period with focus on description of patients where treatment was terminated on arrival, hence evaluation of the exclusion criteria as well as analysis of patients where treatment was initiated and especially outcome relative to chosen mechanical support strategy.

Description of the cohort

All cases of refractory cardiac arrest in the Region of Southern Denmark admitted at Odense University Hospital for possible eCPR in the period of 2015-2020.

Data and biological material

All data is collected from electronic patient charts.