Clin Exp Emerg Med.
2018 Jun;5(2):100-106. 10.15441/ceem.17.219.
Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study
- Affiliations
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- 1Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- 2Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- 3Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea.
- 4Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 5Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- 6Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
- 7Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
- 8Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea.
- 9Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
- 10Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea. bbukkuk@hanmail.net
- 11Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- KMID: 2416922
- DOI: http://doi.org/10.15441/ceem.17.219
Abstract
OBJECTIVE
A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea.
METHODS
In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics.
RESULTS
Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers.
CONCLUSION
A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.
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