Waqas Akhtar, Eftychia Galiatsou, Sofia Pinto, Maria Comanici, Emanuele Gerlando, Timothy Pitt, Joe Hughes, Olaf Maunz, Elia Keating, Michael Taylor, Anthony McKay, Julia Gangata, Sumesh Thiruthalil, Eleanor Ross, Sophie Avetoom, Jane Durrant, Jill Smith, Ciara Collins, Majid Akhtar, Anand Jothidasan, Maria Monteagudo-Vela, Mark Mason, Ian McGovern, Jerry Mitchell, Hatem Soliman Aboumarie, Orinta Kviatkovske, Caroline Bullen, Sachin Mehta, Sundeep Kaul, Donna Hall, Clara Hernandez Caballero, Ana Hurtado, Nick Lees, Vasileios Panoulas, Alex Rosenberg
{"title":"提高难治性心脏骤停体外心肺复苏的质量和结果：凤凰ECPR项目。","authors":"Waqas Akhtar, Eftychia Galiatsou, Sofia Pinto, Maria Comanici, Emanuele Gerlando, Timothy Pitt, Joe Hughes, Olaf Maunz, Elia Keating, Michael Taylor, Anthony McKay, Julia Gangata, Sumesh Thiruthalil, Eleanor Ross, Sophie Avetoom, Jane Durrant, Jill Smith, Ciara Collins, Majid Akhtar, Anand Jothidasan, Maria Monteagudo-Vela, Mark Mason, Ian McGovern, Jerry Mitchell, Hatem Soliman Aboumarie, Orinta Kviatkovske, Caroline Bullen, Sachin Mehta, Sundeep Kaul, Donna Hall, Clara Hernandez Caballero, Ana Hurtado, Nick Lees, Vasileios Panoulas, Alex Rosenberg","doi":"10.1136/bmjoq-2024-002934","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all ECPR cases at Harefield Hospital between April 2018 and April 2023. A new structured system including a systematic screening process, strict exclusion criteria, assessment of resuscitation adequacy through physiological stop criteria, drilled and standardised cannulation process, post-resuscitation care and neuroprognostication was rolled out on 1 April 2023. A comparison of ECPR performed pre and post was undertaken.</p><p><strong>Results: </strong>With the institution of the new system, 13 patients were treated with ECPR over 1 year; of which nine (69.2%) survived with good neurological outcomes at 6 months. In the preceding 3 years, there had been 22 cases; of which, two survived (9.1%). This was a statistically significant higher survival with HR of 4.56 (CI 2.1, 10.2, p<0.05).The average length of hospital stay in the new system was 61.3 days; of which, 32.4 days were in the intensive care unit.</p><p><strong>Conclusions: </strong>This study shows that it is possible to significantly improve outcomes in ECPR in a single centre by introducing into standard practice, a high-quality bundle of care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804202/pdf/","citationCount":"0","resultStr":"{\"title\":\"Improving quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project.\",\"authors\":\"Waqas Akhtar, Eftychia Galiatsou, Sofia Pinto, Maria Comanici, Emanuele Gerlando, Timothy Pitt, Joe Hughes, Olaf Maunz, Elia Keating, Michael Taylor, Anthony McKay, Julia Gangata, Sumesh Thiruthalil, Eleanor Ross, Sophie Avetoom, Jane Durrant, Jill Smith, Ciara Collins, Majid Akhtar, Anand Jothidasan, Maria Monteagudo-Vela, Mark Mason, Ian McGovern, Jerry Mitchell, Hatem Soliman Aboumarie, Orinta Kviatkovske, Caroline Bullen, Sachin Mehta, Sundeep Kaul, Donna Hall, Clara Hernandez Caballero, Ana Hurtado, Nick Lees, Vasileios Panoulas, Alex Rosenberg\",\"doi\":\"10.1136/bmjoq-2024-002934\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all ECPR cases at Harefield Hospital between April 2018 and April 2023. A new structured system including a systematic screening process, strict exclusion criteria, assessment of resuscitation adequacy through physiological stop criteria, drilled and standardised cannulation process, post-resuscitation care and neuroprognostication was rolled out on 1 April 2023. A comparison of ECPR performed pre and post was undertaken.</p><p><strong>Results: </strong>With the institution of the new system, 13 patients were treated with ECPR over 1 year; of which nine (69.2%) survived with good neurological outcomes at 6 months. In the preceding 3 years, there had been 22 cases; of which, two survived (9.1%). This was a statistically significant higher survival with HR of 4.56 (CI 2.1, 10.2, p<0.05).The average length of hospital stay in the new system was 61.3 days; of which, 32.4 days were in the intensive care unit.</p><p><strong>Conclusions: </strong>This study shows that it is possible to significantly improve outcomes in ECPR in a single centre by introducing into standard practice, a high-quality bundle of care.</p>\",\"PeriodicalId\":9052,\"journal\":{\"name\":\"BMJ Open Quality\",\"volume\":\"14 1\",\"pages\":\"\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-02-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804202/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open Quality\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjoq-2024-002934\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Quality","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/bmjoq-2024-002934","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Improving quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project.
Background: Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.
Methods: A retrospective analysis was performed of all ECPR cases at Harefield Hospital between April 2018 and April 2023. A new structured system including a systematic screening process, strict exclusion criteria, assessment of resuscitation adequacy through physiological stop criteria, drilled and standardised cannulation process, post-resuscitation care and neuroprognostication was rolled out on 1 April 2023. A comparison of ECPR performed pre and post was undertaken.
Results: With the institution of the new system, 13 patients were treated with ECPR over 1 year; of which nine (69.2%) survived with good neurological outcomes at 6 months. In the preceding 3 years, there had been 22 cases; of which, two survived (9.1%). This was a statistically significant higher survival with HR of 4.56 (CI 2.1, 10.2, p<0.05).The average length of hospital stay in the new system was 61.3 days; of which, 32.4 days were in the intensive care unit.
Conclusions: This study shows that it is possible to significantly improve outcomes in ECPR in a single centre by introducing into standard practice, a high-quality bundle of care.
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