AUTHOR=Springer A. , Dreher A. , Reimers J. , Kaiser L. , Bahlmann E. , van der Schalk H. , Wohlmuth P. , Gessler N. , Hassan K. , Wietz J. , Bein B. , Spangenberg T. , Willems S. , Hakmi S. , Tigges E. 

TITLE=Prognostic influence of mechanical cardiopulmonary resuscitation on survival in patients with out-of-hospital cardiac arrest undergoing ECPR on VA-ECMO

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1266189

DOI=10.3389/fcvm.2023.1266189

ISSN=2297-055X

ABSTRACT=The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (ECPR) in selected patients (pts) after out of hospital cardiac arrest (OHCA) is an established method if return of spontaneous circulation cannot be achieved. Automated chest compression devices (ACCD) facilitate transportation of pts under ongoing CPR and might improve outcome. We thus sought to evaluate prognostic influence of mechanical CPR using ACCD in pts presenting with OHCA treated with ECPR including VA-ECMO.We retrospectively analysed data of 171 consecutive pts treated for OHCA using ECPR in our cardiac arrest center from the years 2016 to 2022. A Cox proportional hazards model was used to identify characteristics related with survival.Results: Of the 171 analysed pts (84% male, mean age 56 years) 12% survived the initial hospitalization with favourable neurological outcome. Primary reason for OHCA was an acute coronary event (72%) followed by primary arrhythmia (9%) and non-ischaemic cardiogenic shock (6.7%). In most cases, the collapse was witnessed (83%) and bystander CPR was performed (83%).The median time from collapse to VA-ECMO was 81 minutes (min) (Q1: 69 min, Q3: 98 min). No survival benefit was seen for pts resuscitated using ACCD. Pts in whom an ACCD was used presented with overall longer times from collapse to ECMO than those who were resuscitated manually (83 min [Q1: 70 min, Q3: 98 min] vs. 69 min [Q1: 57 min, Q3: 84 min], p=0.004).No overall survival benefit for the use of ACCD before ECPR is established was found, possibly due to longer overall CPR duration. Arguably, caused by the limited availability of ACCD in pre-clinical paramedic service at the time of observation. Increasing availability of these devices might thus improve treatment of OHCA, presumably by providing efficient CPR during transportation and transfer.