The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation : Program description, performance, and outcomes
© 2020 The Authors..
BACKGROUND: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA).
METHODS: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit.
FINDINGS: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31-56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2.
INTERPRETATION: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities.
FUNDING: The Helmsley Charitable Trust.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29-30 |
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| Enthalten in: |
EClinicalMedicine - 29-30(2020) vom: 22. Dez., Seite 100632 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bartos, Jason A [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 19.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.eclinm.2020.100632 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320012921 |
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| 100 | 1 | |a Bartos, Jason A |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation |b Program description, performance, and outcomes |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Revised 19.04.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2020 The Authors. | ||
| 520 | |a BACKGROUND: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA) | ||
| 520 | |a METHODS: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit | ||
| 520 | |a FINDINGS: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31-56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2 | ||
| 520 | |a INTERPRETATION: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities | ||
| 520 | |a FUNDING: The Helmsley Charitable Trust | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ABG, arterial blood gas | |
| 650 | 4 | |a ACLS, advanced cardiac life support | |
| 650 | 4 | |a CCL, cardiac catheterization laboratory | |
| 650 | 4 | |a CPC, Cerebral Performance Category | |
| 650 | 4 | |a CPR, cardiopulmonary resuscitation | |
| 650 | 4 | |a Cardiac arrest | |
| 650 | 4 | |a ECMO, extracorporeal membrane oxygenation | |
| 650 | 4 | |a EMS, emergency medical services | |
| 650 | 4 | |a Extracorporeal cardiopulmonary resuscitation | |
| 650 | 4 | |a Extracorporeal membrane oxygenation | |
| 650 | 4 | |a OHCA, out-of-hospital cardiac arrest | |
| 650 | 4 | |a PaO2, arterial partial pressure of oxygen | |
| 650 | 4 | |a ROSC, return of spontaneous circulation | |
| 650 | 4 | |a Refractory ventricular fibrillation | |
| 650 | 4 | |a SEM, standard error of the mean | |
| 650 | 4 | |a Sudden cardiac death | |
| 650 | 4 | |a VF/VT, ventricular fibrillation/ventricular tachycardia | |
| 700 | 1 | |a Frascone, R J |e verfasserin |4 aut | |
| 700 | 1 | |a Conterato, Marc |e verfasserin |4 aut | |
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| 700 | 1 | |a Vuljaj, Nik |e verfasserin |4 aut | |
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| 700 | 1 | |a Peterson, Bjorn K |e verfasserin |4 aut | |
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| 700 | 1 | |a Ham, Kealy |e verfasserin |4 aut | |
| 700 | 1 | |a Bruen, Charles |e verfasserin |4 aut | |
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