title: Out-of-hospital cardiac arrest: the prospect of E-CPR in the Maastricht region.
abstract: OBJECTIVE
  The current outcome of out-of-hospital cardiac arrest (OHCA) patients in the Maastricht region was analysed with the prospect of implementing extracorporeal cardiopulmonary resuscitation (E-CPR).
  
  
  METHODS
  A retrospective analysis of adult patients who were resuscitated for OHCA during a 24-month period was performed.
  
  
  RESULTS
  195 patients (age 66 [57-75] years, 82 % male) were resuscitated for OHCA by the emergency medical services and survived to admission at the emergency department. Survival to hospital discharge was 46.2 %. Notable differences between non-survivors and survivors were observed and included: age (70 [58-79] years) vs. (63 [55-72] years, p = 0.01), chronic heart failure (18 vs. 7 %, p = 0.02), shockable rhythm (67 vs. 99 %, p < 0.01), and return of spontaneous circulation (ROSC) at departure from the site of the arrest (46 vs. 99 %, p < 0.01) and on arrival to the emergency department (43 vs. 98 %, p < 0.01), respectively. Acute coronary syndrome was diagnosed in 32 % of non-survivors vs. 59 % among survivors, p < 0.01. Therapeutic hypothermia was provided in non-survivors (20 %) vs. survivors (43 %), p < 0.01. Percutaneous coronary intervention (PCI) was performed in 14 % of non-survivors while 52 % of survivors received PCI (p < 0.01). No statistical significance was observed in terms of gender, witnessed arrest, bystander CPR, or automated external defibrillator deployed among the cohort. At hospital discharge, moderately severe neurological disability was present in six survivors.
  
  
  CONCLUSIONS
  These observations are compatible with the notion that a shockable rhythm, ROSC, and post-arrest care improve survival outcome. Potentially, initiating E-CPR in the resuscitation phase in patients with a shockable rhythm and no ROSC might serve as a bridge to definite treatment and improve survival outcome.
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. ajay.sharma@maastrichtuniversity.nl.
authors.forename: A S
authors.initials: AS
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: R W M
authors.initials: RW
authors.lastname: Pijls
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.
authors.forename: P W
authors.initials: PW
authors.lastname: Weerwind
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.|Departments of Cardiology and Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: T S R
authors.initials: TS
authors.lastname: Delnoij
authors.affiliation: Department of Transplantation, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: W C
authors.initials: WC
authors.lastname: de Jong
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: A P M
authors.initials: AP
authors.lastname: Gorgels
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Maessen
keywords: Extracorporeal cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Resuscitation; Return of spontaneous circulation; Shockable rhythm; Survivors