Extracorporeal Cardiopulmonary Resuscitation: Outcomes Improve With Center Experience - 18/01/25

Doi : 10.1016/j.annemergmed.2024.12.004

Ingrid Magnet, MD ^a, Wilhelm Behringer, MD ^a, Felix Eibensteiner, MD ^a, Florian Ettl, MD ^a, Jürgen Grafeneder, MD ^a, Gottfried Heinz, MD ^b, Michael Holzer, MD ^a, Mario Krammel, MD ^f, Elisabeth Lobmeyr, MD ^a, Heidrun Losert, MD ^a, Matthias Müller, MD ^a, Alexander Nürnberger, MD ^a, Julia Riebandt, MD ^c, Christoph Schriefl, MD ^a, Thomas Staudinger, MD ^d, Alexandra-Maria Stommel, MD ^a, Christoph Testori, MD ^a, Christian Zauner, MD ^e, Andrea Zeiner-Schatzl, MD ^a, Michael Poppe, MD ^a,^⁎
^a Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
^b Department of Medicine II, Medical University of Vienna, Vienna, Austria
^c Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
^d Department of Medicine I, Medical University of Vienna, Vienna, Austria
^e Department of Medicine III, Medical University of Vienna, Vienna, Austria
^f Emergency Medical Service Vienna, Vienna, Austria

^∗Corresponding Author.

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Abstract

Study objective

Extracorporeal cardiopulmonary resuscitation (eCPR) is a rescue therapy for selected patients when conventional cardiopulmonary resuscitation (CPR) fails. Current evidence suggests that the success of eCPR depends on well-structured in- and out-of-hospital protocols. This article describes the Vienna eCPR program, and the interventions implemented to improve clinical processes and patient outcomes.

Methods

In this retrospective study, we report on all patients with inhospital and out-of-hospital cardiac arrest treated with eCPR at our department between 2020 and 2023. During this period, the program was restructured, including the introduction of out-of-hospital and inhospital algorithms and interprofessional training. The primary endpoint was survival with favorable neurologic outcomes at 6 months, defined as a cerebral performance category score of 1 or 2.

Results

Overall, 192 patients were treated with eCPR. The proportion of patients with favorable neurologic outcomes was 25% (n=48), increasing each year: 15% (5/34) in 2020, 19% (8/42) in 2021, 23% (12/53) in 2022, and 37% (23/63) in 2023. This was particularly true for out-of-hospital cardiac arrest patients: 7% (2/29), 14% (4/29), 17% (7/41), and 32% (16/50), respectively. Simultaneously, rates of witnessed arrest, bystander CPR, and initial shockable rhythm increased, whereas low-flow durations decreased.

Conclusion

After restructuring the Vienna eCPR program, we were able to improve survival rates with favorable neurologic outcomes after eCPR. This improvement was accompanied with increased case volumes, rates of witnessed arrest, bystander CPR, and initial shockable rhythm, and decreased low-flow durations. The learning curve we observed illustrates that outcomes can improve with experience, a summation effect of training, patient selection, and process standardization.

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Keywords : Extracorporeal membrane oxygenation, Cardiac arrest, Out-of-hospital cardiac arrest, Quality improvement, Resuscitation

Plan

Introduction

Materials and Methods

Study Setting

Course of eCPR

Protocols, Training, and Quality Management

Study Design

Selection of Participants and Measurements

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Nicholas M. Mohr, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: MP and IM conceptualized the study. IM, FE, FE, JG, MH, EL, HL, MM, AN, CS, AMS, CT, AZS, and MP performed data curation. MP, IM, and WB developed the methodology of the study. MP supervised the study. WB, GH, JR, TS, CZ, and MK validated the study. IM and MP wrote the original draft. IM, WB, FE, FE, JG, GH, MH, MK, EL, HL, MM, AN, JR, CS, TS, AMS, CT, CZ, AZS, and MP performed writing, reviewing, and editing of the manuscript. MP takes responsibility for the paper as a whole.
	Data sharing statement: The data that support the findings of this study are available from the corresponding author (MP) on reasonable request.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors of the paper report no such relationships.