French guidelines for Cardio Pulmonary Resuscitation (CPR) consider Extra-Corporeal Life Support (ECLS) as one option in Refractory out-of hospital Cardiac Arrest (ROHCA) patients with a no-flow less than five minutes and absence of spontaneous circulation 30 minutes after initiation of advanced CPR. Duration of both pre-CPR arrest (no-flow) and of CPR (low-flow) have been systematically highlighted as crucial prognostic factors in all observational studies focused on ROHCA. In order to shorten the time to ECLS initiation, the most recent European Resuscitation Council guidelines recommend, in eligible ROHCA patients, a fast track access to ECLS implantation. CHRU Nancy elaborated an operational strategy which was designed to improve the enrolment of eligible ROHCA patients and to reduce the delay time between recognition and ECLS initiation. The objective of the present register was to assess prospectively the impact of this new operational strategy over a 5 years period.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
50
ROHCA must be witnessed with onset of bystander CPR and an immediate call to Emergency Dispatch. Furthermore, to minimize any loss of time, all qualified geographical locations are directly incorporated in the regulation software of the center for medical emergency control. Patients suitable for vaECMO implantation were identified as early as possible by the Medical Dispatcher at the Emergency Call Dispatch Center. Bystanders pursued CPR until Mobile Intensive Care Unit (MICU) arrival. OHCA was considered refractory after 10 min of CPR initiating the transport by MICU to the hospital such that the vaECMO intervention could be performed. The resuscitation was pursued during the transfer to hospital. An automated chest compression device was used in order to minimize interruption periods. The intensivists and cardiac surgeons stood ready to implant the vaECMO surgically in the catheterization laboratory where a percutaneous coronary intervention was subsequently performed.
Number of survivors without neurological sequelae Number of survivors without neurological sequelae (DRS scale from 0 to 6)
Number of survivors without neurological sequelae (DRS scale from 0 to 6)
Time frame: 1 year
Number of survivors with or without neurological sequelae.
Number of survivors with or without neurological sequelae (DRS from 0 to 29)
Time frame: at 3 months
Number of survivors with or without neurological sequelae.
European quality of life scale EQ-5D at 3 months
Time frame: at 3 months
Ischemia-reperfusion assessment
Amount of fluid infused
Time frame: from ECMO implantation and day 3
Renal failure
Worst KDIGO stage
Time frame: ECMO implantation - Day 1- Day 3
Hepatic failure
Worst values of PT/bilirubin/ AST and ALT
Time frame: ECMO implantation - Day 1 - Day 3
Coagulation Failure
platelets/PT/Fibrinogen
Time frame: ECMO implantation- Day 1 - Day 3
Respiratory failure
PaO2/iFO2 value
Time frame: ECMO implantation - Day 1- Day 3
Hemodynamic Failure
Amount of Norepinephrine infused
Time frame: from ECMO implantation and day 3
Quality of Resuscitation
Total duration of the resuscitation: from collapse to ECMO implantation
Time frame: from collapse to ECMO implantation (up to 60 minutes)
Pupillary status
Pupillary status
Time frame: at arrival in intensive care - Hour 0 - Hour 6 - Hour 12 - Day 1
Lactate
amount of Lactate
Time frame: Hour 0 - Hour 6 - Hour 12 - Day 1
bispectral index
bispectral index
Time frame: at arrival in intensive care - Hour 6 - Hour 12 - Day 1
Nosocomial complications
Infection of the canulation site
Time frame: ECMO implantation - Day 1 - Day 3
Nosocomial complications
bacteraemia
Time frame: ECMO implantation - Day 1 - Day 3
Bleeding complications
blood hemostasis disorder
Time frame: ECMO implantation - Day 1 - Day 3
Bleeding complications
bleeding
Time frame: ECMO implantation - Day 1 - Day 3
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