A concept for the development of a pioneer regional out-of-hospital cardiac arrest program to improve patient outcomes

Abstract

BACKGROUND Immediate initiation of cardiopulmonary resuscitation (CPR) increases chances of restoring spontaneous circulation and survival after out-of-hospital cardiac arrest (OHCA). For some refractory cases, extended cardiopulmonary resuscitation (ECPR) may be a promising option. AIMS The aim of the study was to estimate the possibility of implementation of ECPR procedure to improve current early outcomes of patients after OHCA. METHODS The medical charts of the Province Emergency Station in Poznań from a 12-month period were assessed retrospectively. All OHCA cases were identified and the following potential inclusion criteria for ECPR were analyzed: initial defibrillation rhythm, age between 18 and 65 years, CPR conducted by bystanders, and time to hospital arrival less than 40 minutes. RESULTS In 576 (46.7%) of 1233 identified OHCA cases, CPR was initiated by bystanders and automated external defibrillator was applied only 17 times. An initial defibrillation rhythm was noted in 138 individuals (11.2%). Out of 65 patients who met the ECPR age criterion, 55 underwent CPR by bystanders which lead to a no-flow time that did not exceed 10 minutes. The additional 9 of them would be excluded due to time to hospital arrival. This means that ECPR would be applicable in 46 patients after OHCA. CONCLUSIONS Our analysis showed that in some patients after sudden cardiac arrest, it would have been possible to implement ECPR as a crucial part of the Regional Out-of-Hospital Cardiac Arrest (OHCA) Program, and in consequence, probably to improve early outcomes of patients with refractory and potentially reversible cardiac arrest.