title: Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest.
abstract: OBJECTIVE
  Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation.
  
  
  METHODS
  We performed a secondary analysis from a 52-month prospective registry of consecutive adult non-traumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge.
  
  
  RESULTS
  Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge.
  
  
  CONCLUSIONS
  In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Brian
authors.initials: B
authors.lastname: Grunau
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Frank Xavier
authors.initials: FX
authors.lastname: Scheuermeyer
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Boone
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Joseph
authors.initials: J
authors.lastname: Finkler
authors.affiliation: ††Providence Healthcare Research Institute,Vancouver,BC.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pennington
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Sarah Ann
authors.initials: SA
authors.lastname: Carriere
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Ruth
authors.initials: R
authors.lastname: MacRedmond
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Jamil
authors.initials: J
authors.lastname: Bashir
authors.affiliation: *St. Paul's Hospital,Vancouver,BC.
authors.forename: Jim
authors.initials: J
authors.lastname: Christenson
mesh_terms: D000328:Adult; D000368:Aged; D001955:British Columbia; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality*; D015331:Cohort Studies; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000458:organization & administration*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D015397:Program Evaluation; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D019037:Urban Health Services / Q000458:organization & administration
keywords: ECMO; ECPR; cardiac arrest; cardiopulmonary resuscitation