Advanced Cardiac Life Support, Cardiac Arrest, Cardiopulmonary Resuscitation, Extracorporeal Life Support
Conditions
Keywords
Refractory out-hospital cardiac arrest, Extracorporeal Life Support
Brief summary
French guidelines for Cardio Pulmonary Resuscitation (CPR) consider Extra-Corporeal Life Support (ECLS) as one option in Refractory out-of hospital Cardiac Arrest (ROHCA) patients with a no-flow less than five minutes and absence of spontaneous circulation 30 minutes after initiation of advanced CPR. Duration of both pre-CPR arrest (no-flow) and of CPR (low-flow) have been systematically highlighted as crucial prognostic factors in all observational studies focused on ROHCA. In order to shorten the time to ECLS initiation, the most recent European Resuscitation Council guidelines recommend, in eligible ROHCA patients, a fast track access to ECLS implantation. CHRU Nancy elaborated an operational strategy which was designed to improve the enrolment of eligible ROHCA patients and to reduce the delay time between recognition and ECLS initiation. The objective of the present register was to assess prospectively the impact of this new operational strategy over a 5 years period.
Interventions
PROCEDUREFast track access to vaECMO
ROHCA must be witnessed with onset of bystander CPR and an immediate call to Emergency Dispatch. Furthermore, to minimize any loss of time, all qualified geographical locations are directly incorporated in the regulation software of the center for medical emergency control. Patients suitable for vaECMO implantation were identified as early as possible by the Medical Dispatcher at the Emergency Call Dispatch Center. Bystanders pursued CPR until Mobile Intensive Care Unit (MICU) arrival. OHCA was considered refractory after 10 min of CPR initiating the transport by MICU to the hospital such that the vaECMO intervention could be performed. The resuscitation was pursued during the transfer to hospital. An automated chest compression device was used in order to minimize interruption periods. The intensivists and cardiac surgeons stood ready to implant the vaECMO surgically in the catheterization laboratory where a percutaneous coronary intervention was subsequently performed.
Sponsors
Central Hospital, Nancy, France
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Prospective, monocentric, open, routine care assessment study
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Witnessed out-of-hospital cardiac arrest * in qualified geographical locations * No Return of spontaneous circulation (ROSC) after 10 min of CPR * No Flow \<1 min
Exclusion criteria
* Apparent obvious comorbidities * Patient \< 18 yo * Pregnancy * Patient under protective supervision
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of survivors without neurological sequelae Number of survivors without neurological sequelae (DRS scale from 0 to 6) | 1 year | Number of survivors without neurological sequelae (DRS scale from 0 to 6) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ischemia-reperfusion assessment | from ECMO implantation and day 3 | Amount of fluid infused |
| Renal failure | ECMO implantation - Day 1- Day 3 | Worst KDIGO stage |
| Hepatic failure | ECMO implantation - Day 1 - Day 3 | Worst values of PT/bilirubin/ AST and ALT |
| Coagulation Failure | ECMO implantation- Day 1 - Day 3 | platelets/PT/Fibrinogen |
| Respiratory failure | ECMO implantation - Day 1- Day 3 | PaO2/iFO2 value |
| Hemodynamic Failure | from ECMO implantation and day 3 | Amount of Norepinephrine infused |
| Number of survivors with or without neurological sequelae. | at 3 months | Number of survivors with or without neurological sequelae (DRS from 0 to 29) |
| Pupillary status | at arrival in intensive care - Hour 0 - Hour 6 - Hour 12 - Day 1 | Pupillary status |
| Lactate | Hour 0 - Hour 6 - Hour 12 - Day 1 | amount of Lactate |
| bispectral index | at arrival in intensive care - Hour 6 - Hour 12 - Day 1 | bispectral index |
| Nosocomial complications | ECMO implantation - Day 1 - Day 3 | Infection of the canulation site |
| Bleeding complications | ECMO implantation - Day 1 - Day 3 | blood hemostasis disorder |
| Quality of Resuscitation | from collapse to ECMO implantation (up to 60 minutes) | Total duration of the resuscitation: from collapse to ECMO implantation |
Contacts
Primary ContactAntoine Kimmoun, MD
Backup ContactTahar Chouied, MD
Outcome results
None listed