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Pre-hospital ECPR in an Australian metropolitan setting: a single-arm feasibility assessment-The CPR, pre-hospital ECPR and early reperfusion (CHEER3) study.
Richardson, S A C; Anderson, D; Burrell, A J C; Byrne, T; Coull, J; Diehl, A; Gantner, D; Hoffman, K; Hooper, A; Hopkins, S; Ihle, J; Joyce, P; Le Guen, M; Mahony, E; McGloughlin, S; Nehme, Z; Nickson, C P; Nixon, P; Orosz, J; Riley, B; Sheldrake, J; Stub, D; Thornton, M; Udy, A; Pellegrino, V; Bernard, S.
Affiliation
  • Richardson SAC; The Alfred Hospital, Melbourne, Australia. Sacha.Richardson@alfred.org.au.
  • Anderson D; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Sacha.Richardson@alfred.org.au.
  • Burrell AJC; The Alfred Hospital, Melbourne, Australia.
  • Byrne T; Ambulance Victoria, Melbourne, Australia.
  • Coull J; Department of Paramedicine, Monash University, Melbourne, Australia.
  • Diehl A; The Alfred Hospital, Melbourne, Australia.
  • Gantner D; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Hoffman K; The Alfred Hospital, Melbourne, Australia.
  • Hooper A; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Hopkins S; The Alfred Hospital, Melbourne, Australia.
  • Ihle J; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Joyce P; The Alfred Hospital, Melbourne, Australia.
  • Le Guen M; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Mahony E; The Alfred Hospital, Melbourne, Australia.
  • McGloughlin S; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Nehme Z; The Alfred Hospital, Melbourne, Australia.
  • Nickson CP; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Nixon P; The Alfred Hospital, Melbourne, Australia.
  • Orosz J; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Riley B; Ambulance Victoria, Melbourne, Australia.
  • Sheldrake J; The Alfred Hospital, Melbourne, Australia.
  • Stub D; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Thornton M; The Alfred Hospital, Melbourne, Australia.
  • Udy A; The Alfred Hospital, Melbourne, Australia.
  • Pellegrino V; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • Bernard S; Ambulance Victoria, Melbourne, Australia.
Scand J Trauma Resusc Emerg Med ; 31(1): 100, 2023 Dec 13.
Article in En | MEDLINE | ID: mdl-38093335
ABSTRACT

INTRODUCTION:

Survival from refractory out of hospital cardiac arrest (OHCA) without timely return of spontaneous circulation (ROSC) utilising conventional advanced cardiac life support (ACLS) therapies is dismal. CHEER3 was a safety and feasibility study of pre-hospital deployed extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) for refractory OHCA in metropolitan Australia.

METHODS:

This was a single jurisdiction, single-arm feasibility study. Physicians, with pre-existing ECMO expertise, responded to witnessed OHCA, age < 65 yrs, within 30 min driving-time, using an ECMO equipped rapid response vehicle. If pre-hospital ECPR was undertaken, patients were transported to hospital for investigations and therapies including emergent coronary catheterisation, and standard intensive care (ICU) therapy until either cardiac and neurological recovery or palliation occurred. Analyses were descriptive.

RESULTS:

From February 2020 to May 2023, over 117 days, the team responded to 709 "potential cardiac arrest" emergency calls. 358 were confirmed OHCA. Time from emergency call to scene arrival was 27 min (15-37 min). 10 patients fulfilled the pre-defined inclusion criteria and all were successfully cannulated on scene. Time from emergency call to ECMO initiation was 50 min (35-62 min). Time from decision to ECMO support was 16 min (11-26 min). CPR duration was 46 min (32-62 min). All 10 patients were transferred to hospital for investigations and therapy. 4 patients (40%) survived to hospital discharge neurologically intact (CPC 1/2).

CONCLUSION:

Pre-hospital ECPR was feasible, using an experienced ECMO team from a single-centre. Overall survival was promising in this highly selected group. Further prospective studies are now warranted.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiopulmonary Resuscitation / Out-of-Hospital Cardiac Arrest Limits: Aged / Humans Country/Region as subject: Oceania Language: En Journal: Scand J Trauma Resusc Emerg Med Journal subject: MEDICINA DE EMERGENCIA / TRAUMATOLOGIA Year: 2023 Document type: Article Affiliation country: Australia
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiopulmonary Resuscitation / Out-of-Hospital Cardiac Arrest Limits: Aged / Humans Country/Region as subject: Oceania Language: En Journal: Scand J Trauma Resusc Emerg Med Journal subject: MEDICINA DE EMERGENCIA / TRAUMATOLOGIA Year: 2023 Document type: Article Affiliation country: Australia