Natalie Kruit , Brian Burns , Nicolas Shearer , Jason Hui , Andrew Coggins , Hergen Buscher , Emily Granger , Kevin Ostrowski , Brian Plunkett , Timothy J. Southwood , Paul Forrest , Hannah Braithwaite , Jan Dieleman , Aidan Burrell , Anthony Keech , Mark Dennis
{"title":"院前ECPR治疗难治性心脏骤停- PRECARE试点可行性研究","authors":"Natalie Kruit , Brian Burns , Nicolas Shearer , Jason Hui , Andrew Coggins , Hergen Buscher , Emily Granger , Kevin Ostrowski , Brian Plunkett , Timothy J. Southwood , Paul Forrest , Hannah Braithwaite , Jan Dieleman , Aidan Burrell , Anthony Keech , Mark Dennis","doi":"10.1016/j.resuscitation.2025.110631","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Survival from refractory out of hospital cardiac arrest (OHCA) treated with conventional cardiopulmonary resuscitation (CCPR) remains low. Extracorporeal cardiac resuscitation (ECPR) is increasingly be utilised in refractory OHCA, with outcomes influenced by the duration of cardiac arrest prior establishing ECMO flow (low flow time). Pre-hospital ECPR aims to reduce the low flow time. Pre-hospital physicians may represent a workforce who could deliver ECPR, increasing access and sustainability.</div></div><div><h3>Methods</h3><div>A single-arm open-label feasibility trial of pre-hospital ECPR delivered by pre-hospital physicians. Patients under the age of 70 years with a witnessed collapse, an initial shockable rhythm and within a 45-minute radius of the mobile team were eligible for pre-hospital ECPR. Once extracorporeal support flow was established, patients were transported to one of three ECMO capable centers. The primary aim was to assess the feasibility of pre-hospital ECPR in this setting.</div></div><div><h3>Results</h3><div>From August 2023 to June 2024, over 103 recruitment days, the pre-hospital ECPR team attended 123 confirmed cardiac arrests, 12 (10%) patients received pre-hospital ECPR equating to one case per 8 shifts. All patients were successfully cannulated on scene while the patient was in cardiac arrest. The mean time from dispatch to team arrival was 18.5 min (range 9–29); mean time from decision to ECMO flow was 17 min (range 10–34) and the mean total low flow time (arrest to ECMO flow) was 39 min (range 24–56). Four (33%) patients were successfully liberated from VA ECMO support, 3 (25%) patients survived to hospital discharge neurologically intact (CPC 1–2).</div></div><div><h3>Conclusions</h3><div>Pre-hospital ECPR delivery by trained pre-hospital medical teams is possible and reduces OHCA low flow times. Larger studies are required to assess efficacy and cost effectiveness.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"212 ","pages":"Article 110631"},"PeriodicalIF":4.6000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pre-hospital ECPR for refractory cardiac arrest – The PRECARE pilot feasibility study\",\"authors\":\"Natalie Kruit , Brian Burns , Nicolas Shearer , Jason Hui , Andrew Coggins , Hergen Buscher , Emily Granger , Kevin Ostrowski , Brian Plunkett , Timothy J. Southwood , Paul Forrest , Hannah Braithwaite , Jan Dieleman , Aidan Burrell , Anthony Keech , Mark Dennis\",\"doi\":\"10.1016/j.resuscitation.2025.110631\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Survival from refractory out of hospital cardiac arrest (OHCA) treated with conventional cardiopulmonary resuscitation (CCPR) remains low. Extracorporeal cardiac resuscitation (ECPR) is increasingly be utilised in refractory OHCA, with outcomes influenced by the duration of cardiac arrest prior establishing ECMO flow (low flow time). Pre-hospital ECPR aims to reduce the low flow time. Pre-hospital physicians may represent a workforce who could deliver ECPR, increasing access and sustainability.</div></div><div><h3>Methods</h3><div>A single-arm open-label feasibility trial of pre-hospital ECPR delivered by pre-hospital physicians. Patients under the age of 70 years with a witnessed collapse, an initial shockable rhythm and within a 45-minute radius of the mobile team were eligible for pre-hospital ECPR. Once extracorporeal support flow was established, patients were transported to one of three ECMO capable centers. The primary aim was to assess the feasibility of pre-hospital ECPR in this setting.</div></div><div><h3>Results</h3><div>From August 2023 to June 2024, over 103 recruitment days, the pre-hospital ECPR team attended 123 confirmed cardiac arrests, 12 (10%) patients received pre-hospital ECPR equating to one case per 8 shifts. All patients were successfully cannulated on scene while the patient was in cardiac arrest. The mean time from dispatch to team arrival was 18.5 min (range 9–29); mean time from decision to ECMO flow was 17 min (range 10–34) and the mean total low flow time (arrest to ECMO flow) was 39 min (range 24–56). Four (33%) patients were successfully liberated from VA ECMO support, 3 (25%) patients survived to hospital discharge neurologically intact (CPC 1–2).</div></div><div><h3>Conclusions</h3><div>Pre-hospital ECPR delivery by trained pre-hospital medical teams is possible and reduces OHCA low flow times. Larger studies are required to assess efficacy and cost effectiveness.</div></div>\",\"PeriodicalId\":21052,\"journal\":{\"name\":\"Resuscitation\",\"volume\":\"212 \",\"pages\":\"Article 110631\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-05-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0300957225001431\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300957225001431","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Pre-hospital ECPR for refractory cardiac arrest – The PRECARE pilot feasibility study
Background
Survival from refractory out of hospital cardiac arrest (OHCA) treated with conventional cardiopulmonary resuscitation (CCPR) remains low. Extracorporeal cardiac resuscitation (ECPR) is increasingly be utilised in refractory OHCA, with outcomes influenced by the duration of cardiac arrest prior establishing ECMO flow (low flow time). Pre-hospital ECPR aims to reduce the low flow time. Pre-hospital physicians may represent a workforce who could deliver ECPR, increasing access and sustainability.
Methods
A single-arm open-label feasibility trial of pre-hospital ECPR delivered by pre-hospital physicians. Patients under the age of 70 years with a witnessed collapse, an initial shockable rhythm and within a 45-minute radius of the mobile team were eligible for pre-hospital ECPR. Once extracorporeal support flow was established, patients were transported to one of three ECMO capable centers. The primary aim was to assess the feasibility of pre-hospital ECPR in this setting.
Results
From August 2023 to June 2024, over 103 recruitment days, the pre-hospital ECPR team attended 123 confirmed cardiac arrests, 12 (10%) patients received pre-hospital ECPR equating to one case per 8 shifts. All patients were successfully cannulated on scene while the patient was in cardiac arrest. The mean time from dispatch to team arrival was 18.5 min (range 9–29); mean time from decision to ECMO flow was 17 min (range 10–34) and the mean total low flow time (arrest to ECMO flow) was 39 min (range 24–56). Four (33%) patients were successfully liberated from VA ECMO support, 3 (25%) patients survived to hospital discharge neurologically intact (CPC 1–2).
Conclusions
Pre-hospital ECPR delivery by trained pre-hospital medical teams is possible and reduces OHCA low flow times. Larger studies are required to assess efficacy and cost effectiveness.
期刊介绍:
Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.