Implementation of a Multidisciplinary Team for Initiation of Extracorporeal Cardiopulmonary Resuscitation in Patients Presenting After Out-of-hospital Cardiac Arrest

Abstract

Objectives

Patents with out-of-hospital cardiac arrest (OHCA) are at high risk of death or poor neurologic recovery if spontaneous circulation is not rapidly restored. Emergent mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of extracorporeal cardiopulmonary resuscitation (ECPR) offers a bridge to diagnostic and therapeutic interventions but can be challenging to provide in a timely fashion. Coordination of multidisciplinary institutional resources into an ECMO Shock Team (ECMO-ST) may improve the survival of ECPR patients while concurrently increasing the number of OHCA patients placed on ECMO.

Design

Retrospective cohort study.

Setting

Single-center urban university hospital in the United States with an active mechanical circulatory support and cardiac transplantation program.

Participants

55 OHCA patients who received ECPR after presenting to the emergency department from May 2013 to December 2022.

Interventions

Ad hoc emergent ECPR support versus activation of the ECMO-ST.

Measurements and Main Results

The primary outcome was survival to hospital discharge. Secondary outcomes included time to ECMO cannulation, duration of ECMO support, renal failure requiring dialysis, diagnosis of hypoxic brain injury, intensive care unit length of stay, 6-month survival, and functional neurologic recovery quantified by cerebral performance category score at discharge and 6 months. Implementation of the ECMO-ST was associated with an increase in the rate of survival to hospital discharge from 22% (2/9 patients) to 52% (24/46 patients), although the result was not statistically significant due to the small sample size of the preintervention cohort. A total of 69% of those discharged from the hospital had favorable neurologic function as defined by cerebral performance category scores of 1-2.

Conclusions

The organization and implementation of a multidisciplinary institutional ECPR response team trended toward an association with higher rates of survival to hospital discharge, with favorable neurologic function in patients presenting to the emergency department after OHCA.