Out of hospital cardiac arrest in Western Sydney-an analysis of outcomes and estimation of future eCPR eligibility

Pramod Chandru; Tatum Priyambada Mitra; Nitesh Dutt Dhanekula; Mark Dennis; Adam Eslick; Natalie Kruit; Andrew Coggins

doi:10.1186/s12873-022-00587-8

Out of hospital cardiac arrest in Western Sydney-an analysis of outcomes and estimation of future eCPR eligibility

BMC Emerg Med. 2022 Feb 28;22(1):31. doi: 10.1186/s12873-022-00587-8.

Authors

Pramod Chandru¹, Tatum Priyambada Mitra², Nitesh Dutt Dhanekula^{3

2}, Mark Dennis^{2

4}, Adam Eslick^{2

5}, Natalie Kruit^{2

5}, Andrew Coggins^{3

6}

Affiliations

¹ Emergency Department, Westmead Hospital, Sydney, NSW, 2145, Australia. Pramod.chandru@health.nsw.gov.au.
² Westmead Clinical School, The University of Sydney, Sydney, Australia.
³ Emergency Department, Westmead Hospital, Sydney, NSW, 2145, Australia.
⁴ Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Department of Anaesthetics, Westmead Hospital, Sydney, Australia.
⁶ Simulated Learning Environment for Clinical Training (SilECT), Sydney, Australia.

Abstract

Background: Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres.

Methods: A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly.

Results: In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n = 58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within "office hours" and no case obtained a return of spontaneous circulation standard advanced life support.

Conclusions: In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

Keywords: ECMO; Out of Hospital Cardiac Arrest; Service Planning; Utstein; eCPR.

Publication types

Observational Study

MeSH terms

Cardiopulmonary Resuscitation*
Extracorporeal Membrane Oxygenation*
Humans
Middle Aged
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Registries
Retrospective Studies
Treatment Outcome