Abstract 280: Prehospital ECLS for Refractory Cardiac Arrest: Safety and Feasibility Study
Background: Extra Corporeal Life Support (ECLS) has been introduced in the treatment of refractory cardiac arrest (RCA). Several studies have assessed the use of ECLS in RCA once the patient has reached the hospital. The time between RCA and implementation of ECLS (low flow time) is one of the succesfull prognostic factors for survival. Pre hospital ECLS(PH-ECLS) implementation could decrease access time. Hence, we decided to assess the feasibility and safety of PH-ECLS implementation in a pilot study to reduce the low flow time.
Methodology: We have developed a PH-ECLS team. This team was composed by 2 emergency physicians, 1 nurse, 1 paramedic. Patients were included prospectively and consecutively if the following criteria were gathered: they had a witnessed CA; CPR was initiated within the first 5 minutes and/or there were signs of life during CPR; an PH-ECLS team was available and absence of severe comorbidities.
According to national guideline, RCA was defined failed after 30 minutes of ALS. The ECLS insertion started after this 30 minutes of ACLS. The insertion technics was a surgical opening of the scarpa to repair the vessel. The insertion was done by Seldinger technics.
Results: From 10/2011 to 01/2013, 17 patients with out of hospital CA were included. Results are resumed in Table 1.
Discussion: This study shows the safety and feasibility to insert ECLS for OHCA on scene by emergency physician. The success rate and the insertion time are similar compare to the same technic in hospital by surgeon. One of the failed insertions was due to the obesity of the patient. Within this sample, one patient survived without sequel. However this study was not designed for survival, only for the safety and feasibility. One of the limitations in this work was the delay to define a RCA. The defined time of 30 minutes of ALS was too long to hope survivor regarding to the literature. PH-ECLS can be a solution to reduce the low flow time but a randomized study is required to evaluate the effect on survivors.
- © 2013 by American Heart Association, Inc.