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Vol. 48. Issue 10.
Pages 565-574 (October 2024)
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Vol. 48. Issue 10.
Pages 565-574 (October 2024)
Original article
Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain
Resultados de un programa de reanimación cardiopulmonar extracorpórea para la parada intra y extrahospitalaria en un hospital terciario español
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María Martínez-Martíneza,b,c, María Vidal-Burdeusc,d, Jordi Rieraa,b,c, Aitor Uribarric,d,e,f, Elisabet Gallarta, Laia Milàd, Pau Torrellaa,b, Irene Buerad,e,f, Luis Chiscano-Camona,b, Bruno García del Blancod,e,f, Carlota Vigil-Escalerag, José A. Barrabésc,d,e,f, Jordi Llanerash, Juan Carlos Ruiz-Rodrígueza,b, Cristopher Mazoi, Jorge Moralesj, Ricard Ferrera,b,c, Ignacio Ferreira-Gonzalezc,d,e,f, Eduard Argudoa,b,c,
Corresponding author
eduard.argudo@vallhebron.cat

Corresponding author at: Hospital Universitari Vall d’Hebron, Intensive Care Medicine Department, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain.
a Intensive Care Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
c Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
d Cardiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
e CIBER-CV, Madrid, Spain
f VHIR – Vall d’Hebron Institut de Recerca, Barcelona, Spain
g Cardiac Surgery Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
h Emergency Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
i Transplant Coordination Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
j Sistema d’Emergencies Mèdiques (SEM), Barcelona, Spain
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Tables (5)
Table 1. Extracorporeal cardiopulmonary resuscitation indications and contraindications.
Table 2. Baseline characteristics for survivors and non-survivors (deceased and CPC >2 combined).
Table 3. Cardiac arrest characteristics for survivors and non survivors (deceased and CPC >2 combined at 180 days).
Table 4. Complications for survivors and non survivors (deceased and CPC >2 combined at 180 days).
Table 5. ECPR patients in our study compared to CHEER,19 Porto,20 ARREST,9 Prague OHCA10,21 and Inception11 studies.
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Abstract
Objective

To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences.

Design

Retrospective observational cohort study.

Setting

One tertiary referral university hospital in Spain.

Patients

All adult patients receiving ECPR between January 2019 and April 2023.

Interventions

Prospective collection of variables and follow-up for up to 180 days.

Main variables of interest

To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1–2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation.

Results

Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication.

Conclusions

The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.

Keywords:
ECMO
Cardiac arrest
ECPR
ECLS
Cardiopulmonary resuscitation
Extracorporeal cardiopulmonary resuscitation
Resumen
Objetivo

Analizar si la implementación de un programa multidisciplinario de reanimación cardiopulmonar extracorpórea (ECPR) en un hospital terciario en España es factible y puede conseguir buenos resultados de supervivencia, similares a las experiencias publicadas internacionalmente.

Diseño

Estudio de cohortes observacional retrospectivo.

Ámbito

Hospital universitario de referencia terciaria en España.

Pacientes

Todos los pacientes adultos que recibieron ECPR entre enero de 2019 y abril de 2023.

Intervenciones

Recogida de variables prospectiva y seguimiento hasta 180 días.

Variables de interés principales

Para evaluar los resultados, se utilizó la supervivencia con buen resultado neurológico definida como un valor de 1–2 a los 180 días en la escala Cerebral Performance Categories. Se recogieron variables secundarias incluyendo las características de la parada cardíaca, la canulación, complicaciones, resultados, causa de muerte y donación de órganos.

Resultados

Cincuenta y cuatro pacientes recibieron ECPR, 29 por parada cardíaca extrahospitalaria y 25 por intrahospitalaria. Se identificó un ritmo inicial desfibrilable en 27 (50%) pacientes. La causa más frecuente de parada cardíaca fue el síndrome coronario agudo [29 (53.7%)] seguido de la embolia pulmonar [7 (13%)] y la hipotermia accidental [5 (9.3%)]. Dieciséis (29.6%) pacientes estaban vivos a los 180 días, 15 con buen resultado neurológico. Diez pacientes de los fallecidos (30.3%) fueron donantes de órganos.

Conclusiones

La implementación de un programa ECPR multidisciplinario en un centro de referencia de ECMO en España es factible y puede conducir a buenos resultados de supervivencia y donantes de órganos válidos.

Palabras clave:
ECMO
Parada cardíaca
ECPR
RCPE
Reanimación cardiopulmonar
Reanimación cardiopulmonar extracorpórea

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