1
|
Linde L, Mørk SR, Gregers E, Andreasen JB, Lassen JF, Ravn HB, Schmidt H, Riber LP, Thomassen SA, Laugesen H, Eiskjær H, Terkelsen CJ, Christensen S, Tang M, Moeller-Soerensen H, Holmvang L, Kjaergaard J, Hassager C, Moller JE. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest. Heart 2023; 109:216-222. [PMID: 36371665 PMCID: PMC9872231 DOI: 10.1136/heartjnl-2022-321405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/12/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To describe characteristics of patients admitted with refractory cardiac arrest for possible extracorporeal cardiopulmonary resuscitation (ECPR) and gain insight into the reasons for refraining from treatment in some. METHODS Nationwide retrospective cohort study involving all tertiary centres providing ECPR in Denmark. Consecutive patients admitted with ongoing chest compression for evaluation for ECPR treatment were enrolled. Presenting characteristics, duration of no-flow and low-flow time, end-tidal carbon dioxide (ETCO2), lactate and pH, and recording of reasons for refraining from ECPR documented by the treating team were recorded. Outcomes were survival to intensive care unit admission and survival to hospital discharge. RESULTS Of 579 patients admitted with refractory cardiac arrest for possible ECPR, 221 patients (38%) proceeded to ECPR and 358 patients (62%) were not considered candidates. Median prehospital low-flow time was 70 min (IQR 56 to 85) in ECPR patients and 62 min (48 to 81) in no-ECPR patients, p<0.001. Intra-arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. The leading causes for not initiating ECPR stated by the treating team were duration of low-flow time in 39%, severe metabolic derangement in 35%, and in 31% low ETCO2. The prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or prehospital low-flow time combined with low ETCO2. Survival to discharge was only achieved in six patients (1.7%) in the no-ECPR group. CONCLUSIONS In this large nationwide study of patients admitted for possible ECPR, two-thirds of patients were not treated with ECPR. The most frequent reasons to abstain from ECPR were long duration of prehospital low-flow time, metabolic derangement and low ETCO2.
Collapse
Affiliation(s)
- Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Sisse Anette Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark,Department Clinical Medicine, Copenhagen University, Kobenhavn, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark,Department Clinical Medicine, Copenhagen University, Kobenhavn, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Odense University Hospital, Odense, Denmark .,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| |
Collapse
|
2
|
Chavez S, Crowe R, Huebinger R, Chan HK, Gill J, Villa N, Pancyzk M, Jarvis J, Bobrow B. Perspective of emergency medical services (EMS) professionals on changes in resources, cardiac arrest care and burnout in Texas during the COVID-19 pandemic. Am J Emerg Med 2022; 62:118-122. [PMID: 36117017 PMCID: PMC9420308 DOI: 10.1016/j.ajem.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Summer Chavez
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States; Department of Health Systems and Population Health Sciences, University of Houston, Houston, TX, United States.
| | | | - Ryan Huebinger
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Hei Kit Chan
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Joseph Gill
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Normandy Villa
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Micah Pancyzk
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Jeff Jarvis
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States; Williamson County EMS, Georgetown, TX, United States
| | - Bentley Bobrow
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| |
Collapse
|
3
|
Factors influencing prehospital physicians' decisions to initiate advanced resuscitation for asystolic out-of-hospital cardiac arrest patients. Resuscitation 2022; 177:19-27. [PMID: 35760227 DOI: 10.1016/j.resuscitation.2022.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The decision to initiate or continue advanced life support (ALS) in out-of-hospital cardiac arrest (OHCA) could be difficult due to the lack of information and contextual elements, especially in non-shockable rhythms. This study aims to explore factors associated with clinicians' decision to initiate or continue ALS and the conditions associated with higher variability in asystolic patients. METHODS This retrospective observational study enrolled 2653 asystolic patients on whom either ALS was attempted or not by the emergency medical services (EMS) physician. A multivariable logistic regression analysis was performed to find the factors associated with the decision to access ALS. A subgroup analysis was performed on patients with a predicted probability of ALS between 35% and 65%. The single physicians' behaviour was compared to that predicted by the model taking into account the entire agency. RESULTS Age, location of event, bystander CPR and EMS-witnessed event were independent factors influencing physicians' choices about ALS. Non-medical OHCA, younger patients, less experienced physicians, presence of breath activity at the emergency call and a longer time for ALS arrival were more frequent among cases with an expected higher variability in behaviours with ALS. Significant variability was detected between physicians. CONCLUSIONS Significant inter-physician variability in access to ALS could be present within the same EMS, especially among less experienced physicians, non-medical OHCA and in presence of signs of life during emergency call. This arbitrariness has been observed and should be properly addressed by EMS team members as it raises ethical issues regarding the disparity in treatment.
Collapse
|