Article (Scientific journals)
Feasibility of extracorporeal membrane oxygenation cardiopulmonary resuscitation by low volume centers in Belgium
MASSION, Paul; JOACHIM, Sabrina; MORIMONT, Philippe et al.
2021In JACEP: Journal of the American College of Emergency Physicians, 2 (3), p. 12484
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Abstract :
[en] Objective: To assess the feasibility of delivering extracorporeal cardiopulmonary resuscitation (ECPR) in refractory out-of-hospital cardiac arrests (OHCA) by low volume extracorporeal membrane oxygenation (ECMO) centers and to explore pre-ECPR predictors of survival. Methods: Between 2016 and 2020, we studied 21 ECPR patients admitted in 2 tertiary ECMO centers in Liège, Belgium. Our ECPR protocol was based on 6 prehospital criteria (no flow < 3 minutes, low flow < 60 minutes, initial shockable rhythm, end-tidal CO2 > 15 mmHg, age < 65 years, and absence of comorbidities). A dedicated training, prehospital checklist and call number for 24/7 ECMO team assistance were implemented. Hemodynamics and blood gases on admission also were assessed. Results: Twenty-one (28%) out of 75 refractory OHCA patients referred were treated by ECPR, with a hospital survival rate of 43% (n = 9/21), comparable to ECPR results from the international extracorporeal life support organization registry. Transient return of spontaneous circulation before ECPR (89% in survivors vs 17% in non-survivors, P = 0.002) and higher initial serum bicarbonate (med [P25-P75] 14.0 [10.6-15.2] vs 7.5 [3.7-10.5] mmol/L, P = 0.019) or lower initial base deficit (14.9 [11.9-18.2] vs 21.6 [17.9-28.9] mmol/L, P = 0.039) were associated with a more favorable outcome. Conclusion: In low volume ECMO centers, the implementation of a specific ECPR protocol for refractory OHCA patients is feasible and provides potential clinical benefit. Highly selective inclusion criteria seem essential to select candidates for ECPR. Initial serum bicarbonate and base deficit integrating cumulative cell failure may be relevant pre-ECMO prognostic factors and require larger-scale evaluation. Keywords: extracorporeal cardiopulmonary resuscitation; extracorporeal membrane oxygenation; out‐of‐hospital cardiac arrest; prehospital emergency care.
Disciplines :
Cardiovascular & respiratory systems
Anesthesia & intensive care
Author, co-author :
MASSION, Paul ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
JOACHIM, Sabrina;  Centre Hospitalier Régional de la Citadelle (Liège) - CHR CITADELLE > Soins Intensifs
MORIMONT, Philippe ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
DULIERE, Guy-Loup;  Centre Hospitalier Régional de la Citadelle (Liège) - CHR CITADELLE > Soins Intensifs
BETZ, Romain ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des urgences
BENOIT, Arnaud;  CHU DE LIEGE > Soins Intensifs > 2021
AMABILI, Philippe ;  Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
LAGNY, Marc-Gilbert ;  Centre Hospitalier Universitaire de Liège - CHU > Département infirmier > Infirmiers perfusionnistes
LIZIN, Justin;  Centre Hospitalier Régional de la Citadelle (Liège) - CHR CITADELLE > Soins Intensifs
MASSARO, Anthony;  Centre Hospitalier Régional de la Citadelle (Liège) - CHR CITADELLE > Soins Intensifs
TCHANA-SATO, Vincent  ;  Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service de chirurgie cardio-vasculaire et thoracique
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Language :
English
Title :
Feasibility of extracorporeal membrane oxygenation cardiopulmonary resuscitation by low volume centers in Belgium
Publication date :
22 June 2021
Journal title :
JACEP: Journal of the American College of Emergency Physicians
ISSN :
0361-1124
Publisher :
American College of Emergency Physicians, United States - Michigan
Volume :
2
Issue :
3
Pages :
e12484
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 19 March 2022

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