Abstract 113: ECLS Implementation by Emergency-Intensivist Physician for Refractory Cardiac Arrest
Introduction -Refractory cardiac arrest (RCA) is defined by a persistant cardiac arrest after 20 to 30 minutes of ALS. ExtraCorporeal Life Support (ECLS) is an alternative therapy in selected situations, but requires the presence of a cardiothoracic surgery team. In order to improve availability and implantation delay, we evaluate the faisability of ECLS by emergency physicians / intensiviste.
Methods - Emergency and Intensivist physicians received training from cardiac surgeons. For all RCA with indications for ECLS (according to national guidelines), ECLS was established by a team of 2 trained non-surgeon physicians. We reported success of implantation, delays, complications and survival.
Results - Over the first 12 months, we reported 27 cases of ECLS for RCA. Mean age was 50 years (SD = 12) with a majority of men (74%). Mean no flow duration was 4 minutes (SD = 0,003). Duration of implantation was 24 min (SD +/- 9) with a low flow time (from cardiac arrest to ECLS) of 92 min (+/- 28). ECLS flow was obtained in 25 patients (93%), and was not established in 2 cases (7%). For one patient, an accidental decannulation occurs, with needing of stop ECLS during 11 minutes. Finally, one patient survived with a Glasgow outcome scale of 1 (4%). 11 patients (40%) developed brain death. Overall, no patient need urgent surgical revision.
Conclusion- Implementation of ECLS in RCA by emergency and intensivist physician is feasible, with short delays, good results and without major complication. This strategy must be evaluated to reduce time to ECLS in RCA.
- © 2012 by American Heart Association, Inc.