Abstract 19833: A New Therapeutic Strategy for Refractory Cardiac Arrest Including Prehospital Ecmo: A Comparison Study
Introduction: ECMO is a treatment of refractory cardiac arrest (RCA). The survival rate depends directly on the low flow (LF) period. To reduce LF we have implemented a new RCA management strategy. This work aims to evaluate the impact of this strategy on survival.
Methods: This is an observational retrospective single-center study. The ECMO team is composed of a doctor, a nurse and a paramedic.The ethical committee validated the study.
During period 1 (11 / 2011-12 / 2014), the strategy associated an ECMO team alert after 10 min of ALS, followed by the implementation of ECMO either in-hospital or out of hospital depending on the ECMO team availability.
During period 2 (01-06 / 2015), the strategy associated an ECMO Team alert at the departure of the BLS Ambulance, with a dedicated ECMO team 24/24 H, and a systematic assessment for ECMO implementation either in hospital or out of hospital according to logistical constraints. A specific training was given to dispatch centers, and all ALS units.
Qualitative variables were compared using the χ2 and Fisher exact tests, whereas quantitative variables were compared by Wilcoxon tests.
Results: The results are in Table 1. The characteristics are similar. The significant results when comparing periods 1 and 2 include an increased survival rate, a decreased LF.
Conclusions: The survival rate of RCA treated with ECMO depends on the LF. Unfortunately even by performing a single scoop and run strategy, an important proportion of patients can not be rapidly put on ECMO.
We have developped a LF reduction strategy involving the implementation of ECMO either in hospital or in the out of hospital setting.
The optimization of this strategy by an earlier alert, a dedicated ECMO team and training has a major significant impact on survival. This increase of survival is probably correlated to the decrease of the LF, especially in the prehospital group.
These results need to be confirmed by a RCT comparing in hospital and out of hospital ECMO implementation.
Author Disclosures: L. Lamhaut: Other Research Support; Modest; Maquet. R. Jouffroy: None. R. idialisoa: None. A. Ellinger: None. J. Orsini: None. A. Hutin: None. M. Jaffry: None. C. Dagron: None. F. Loosli: None. J. Jouan: None. K. An: None. C. Spaulding: None. P. Carli: None.
- © 2015 by American Heart Association, Inc.