title: Minnesota Resuscitation Consortium's Advanced Perfusion and Reperfusion Cardiac Life Support Strategy for Out-of-Hospital Refractory Ventricular Fibrillation.
abstract: In 2015, the Minnesota Resuscitation Consortium (MRC) implemented an advanced perfusion and reperfusion life support strategy designed to improve outcome for patients with out-of-hospital refractory ventricular fibrillation/ventricular tachycardia (VF/VT). We report the outcomes of the initial 3-month period of operations.
  
  
  
  Three emergency medical services systems serving the Minneapolis-St. Paul metro area participated in the protocol. Inclusion criteria included age 18 to 75 years, body habitus accommodating automated Lund University Cardiac Arrest System (LUCAS) cardiopulmonary resuscitation (CPR), and estimated transfer time from the scene to the cardiac catheterization laboratory of ≤30 minutes. Exclusion criteria included known terminal illness, Do Not Resuscitate/Do Not Intubate status, traumatic arrest, and significant bleeding. Refractory VF/VT arrest was defined as failure to achieve sustained return of spontaneous circulation after treatment with 3 direct current shocks and administration of 300 mg of intravenous/intraosseous amiodarone. Patients were transported to the University of Minnesota, where emergent advanced perfusion strategies (extracorporeal membrane oxygenation; ECMO), followed by coronary angiography and primary coronary intervention (PCI), were performed, when appropriate. Over the first 3 months of the protocol, 27 patients were transported with ongoing mechanical CPR. Of these, 18 patients met the inclusion and exclusion criteria. ECMO was placed in 83%. Seventy-eight percent of patients had significant coronary artery disease with a high degree of complexity and 67% received PCI. Seventy-eight percent of patients survived to hospital admission and 55% (10 of 18) survived to hospital discharge, with 50% (9 of 18) achieving good neurological function (cerebral performance categories 1 and 2). No significant ECMO-related complications were encountered.
  
  
  
  The MRC refractory VF/VT protocol is feasible and led to a high functionally favorable survival rate with few complications.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN yanno001@umn.edu.
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Bartos
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Cindy
authors.initials: C
authors.lastname: Martin
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raveendran
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Emil
authors.initials: E
authors.lastname: Missov
authors.affiliation: Department of Emergency Medicine, North Memorial Medical Center, Robbinsdale, MN.
authors.forename: Marc
authors.initials: M
authors.lastname: Conterato
authors.affiliation: Department of Emergency Medicine, Regions Hospital, St. Paul, MN.
authors.forename: R J
authors.initials: RJ
authors.lastname: Frascone
authors.affiliation: Department of Emergency Medicine, North Memorial Medical Center, Robbinsdale, MN.
authors.forename: Alexander
authors.initials: A
authors.lastname: Trembley
authors.affiliation: Department of Emergency Medicine, Ridgeview Medical Center, Waconia, MN.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sipprell
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Stephen
authors.initials: S
authors.lastname: George
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Carlson
authors.affiliation: Division of Surgical Critical Care, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Brunsvold
authors.affiliation: Division of Cardiology, Department of Medicine, Minneapolis VA Healthcare System and University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000379:methods; D014693:Ventricular Fibrillation / Q000628:therapy*
keywords: Extra‐corporeal membrane oxygenation; emergent extracorporeal membrane oxygenation; perfusion; refractory ventricular fibrillation/ventricular tachycardia; resuscitation; ventricular fibrillation