title: Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest.
abstract: BACKGROUND
  Extra corporeal life support (ECLS) has been recently introduced in the treatment of refractory cardiac arrest (CA). Several studies have assessed the use of ECLS in refractory CA once the patients reach hospital. The time between CA and the implementation of ECLS is a major prognostic factor for survival. The main predictive factor for survival is ECLS access time. Pre hospital ECLS implementation could reduce access time. We therefore decided to assess the feasibility and safety of prehospital ECLS implementation (PH-ECLS) in a pilot study.
  
  
  RESULTS
  From January 2011 to January 2012, PH-ECLS implementation for refractory CA was performed in 7 patients by a PH-ECLS team including emergency and/or intensivist physicians and paramedics. Patients were included prospectively and consecutively if the following criteria were met: they had a witnessed CA; CPR was initiated within the first 5 min of CA and/or there were signs of life during CPR; an PH-ECLS team was available and absence of severe comorbidities. ECLS flow was established in all patients. ECLS was started 22 min (±6) after the incision, and 57 min (±21) after the onset of advanced cardiovascular life support (ACLS). In one patient, ECLS was stopped for 10 min due to an accidental decannulation. One patient survived without sequelae. Three patients developed brain death.
  
  
  CONCLUSIONS
  This pilot study suggests that PH-ECLS performed by non-surgeons is safe and feasible. Further studies are needed to confirm the time saved by this strategy and its potential effect on survival.
authors.affiliation: D.A.R. and SAMU de Paris, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France; Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris Descartes University, Paris, France. Electronic address: lionel@lamhaut.fr.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.forename: Romain
authors.initials: R
authors.lastname: Jouffroy
authors.forename: Michaela
authors.initials: M
authors.lastname: Soldan
authors.forename: Pascal
authors.initials: P
authors.lastname: Phillipe
authors.forename: Thibaut
authors.initials: T
authors.lastname: Deluze
authors.forename: Murielle
authors.initials: M
authors.lastname: Jaffry
authors.forename: Christelle
authors.initials: C
authors.lastname: Dagron
authors.forename: Benoit
authors.initials: B
authors.lastname: Vivien
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Kim
authors.initials: K
authors.lastname: An
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
mesh_terms: D000328:Adult; D002423:Cause of Death; D004632:Emergency Medical Services; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies
keywords: Cardiopulmonary resuscitation; Extracorporeal circulation; Sudden death