Potential candidates for ECPR in the catchment area of the University hospital in North Norway

Abstract

Introduction: Some studies report increased survival from out of hospital cardiac arrest (OHCA) with extracorporeal cardiopulmonary resuscitation (ECPR), but the survival rates vary and heterogeneous study populations complicate comparison between studies. Aim: The purpose of this study was to find potential ECPR candidates among all OHCA cases in the catchment area of the University Hospital of North Norway (UNN). Material and methods: In a case series design, we analyzed retrospectively patient record data from the local UNN OHCA registry from January 1 2015 to December 31 2017. Patients were included in the study if they fulfilled the UNN ECPR protocol criteria: Age  80 years, witnessed OHCA with bystander CPR, no-flow time < 5 min, initial VF, VT or PEA and a refractory cardiac arrest. However, we omitted the time limitation of CPR time of maximum 40 min in order to also include the cases that theoretically would have been excluded solely due to distance from the center. Geographical position at the time of arrest was recorded and travel time to the center was estimated. Results: There were 321 cases of OHCA during the study period. Following the ECPR inclusion criteria 138 cases (43%) were included, of which 22 (7%) did not have an exclusion criterium, and were considered eligible for ECPR, but only five had actually been treated with ECPR. Conclusion: Approximately 7 % of OHCA in the UNN area fulfilled the ECPR criteria, and may theoretically have benefited from ECPR treatment. However, with the current requirements of low flow time, only nine would have access to the treatment. Integration of an OHCA-ECPR program may have a small but clinically important effect in selected patients. Our results encourage further investigation of wider application of ECPR, which in the future also should focus on options for the OHCA patients that occurred outside the current geographical limits for this therapy.