Abstract 116: Early Experience in Refractory Cardiac Arrest Treated with Mechanical Cpr, Hypothermia, Ecmo and Early Reperfusion (the Cheer Study)
Background: Survival following out-of-hospital cardiac arrest (OHCA) remains poor. There is growing international interest in utilizing extracorporeal membrane oxygenation assisted CPR (E-CPR) to improve management of cardiac arrest. We seek to describe our experiences in establishing Australia’s first pilot trial into E-CPR for refractory OHCA.
Methods: The CHEER study (mechanical CPR, Hypothermia, ECMO And Early Reperfusion) is a collaboration between The Alfred Hospital and Ambulance Victoria. In the pre-hospital phase patients with refractory cardiac arrest within study recruitment hours are placed on a Zoll AutoPulse™, administered 2L of ice-cold saline to induce therapeutic hypothermia and transported to The Alfred Hospital with on-going standard resuscitation measures. The E-CPR team is mobilised to the emergency department and the femoral artery and vein are percutaneously cannulated during CPR by two intensive care physicians for VA-ECMO, with vascular ultrasound guidance. A coronary angiogram+/-intervention is then performed followed by 24 hours of hypothermia, mechanical ventilation and hemodynamic support.
Results: Three advanced life support ambulances have been trained on the trial protocol and use of the Autopulse since September 2011. Six patients (mean age 50+/-9 years) experienced persistent OHCA, with a mean ischemic time of 79+/-29 minutes. In 5 (83%) patients, return of spontaneous circulation was achieved (2 prior to E-CPR). Mean duration of ECMO support was 51+/-18 hours and average length of hospital stay was 6+/-5 days. Cardiac arrest aetiologies included acute coronary syndrome requiring percutaneous coronary intervention in 4 patients (66%), arrhythmogenic right ventricular cardiomyopathy in one patient and type A aortic dissection in the other. Survival to hospital discharge occurred in 3 patients (50%), all with favourable neurological and functional recovery.
Conclusions: Establishing an E-CPR program for refractory cardiac arrest with cooperation from local ambulance crews is feasible. Further research into the efficacy and resource implications of E-CPR is needed.
- Extracorporeal circulation
- Cardiopulmonary resuscitation
- Percutaneous coronary intervention
- © 2013 by American Heart Association, Inc.