title: Extracorporeal cardiopulmonary resuscitation after out-of-hospital cardiac arrest in a Danish health region.
abstract: BACKGROUND
  Extracorporeal Cardiopulmonary Resuscitation (ECPR) has emerged as a feasible rescue therapy for refractory, normothermic out-of-hospital cardiac arrest (OHCA). Reported survival rates vary and comparison between studies is hampered by heterogeneous study populations, differences in bystander intervention and in pre-hospital emergency service organisation. We aimed to describe the first experiences, treatment details, complications and outcome with ECPR for OHCA in a Danish health region.
  
  
  METHODS
  Retrospective study of adult patients admitted at Aarhus University Hospital, Denmark between 1 January 2011 and 1 July 2015 with witnessed, refractory, normothermic OHCA treated with ECPR. OHCA was managed with pre-hospital advanced airway management and mechanical chest compression during transport. Relevant pre-hospital and in-hospital data were collected with special focus on low-flow time and ECPR duration. Survival to hospital discharge with Cerebral Performance Category (CPC) of 1 and 2 at hospital discharge was the primary endpoint.
  
  
  RESULTS
  Twenty-one patients were included. Median pre-hospital low-flow time was 54 min [range 5-100] and median total low-flow time was 121 min [range 55-192]. Seven patients survived (33%). Survivors had a CPC score of 1 or 2 at hospital discharge. Five survivors had a shockable initial rhythm. In all survivors coronary occlusion was the presumed cause of cardiac arrest.
  
  
  CONCLUSIONS
  Extracorporeal cardiopulmonary resuscitation is feasible as a rescue therapy in normothermic refractory OHCA in highly selected patients. Low-flow time was longer than previously reported. Survival with favourable neurological outcome is possible despite prolonged low-flow duration.
authors.affiliation: Department of Anaesthesia and Intensive Care, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-3371-0503
authors.initials: J
authors.lastname: Fjølner
authors.affiliation: Department of Anaesthesia and Intensive Care, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Greisen
authors.affiliation: Department of Anaesthesia and Intensive Care, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: M R S
authors.initials: MR
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
authors.forename: C J
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: L B
authors.initials: LB
authors.lastname: Ilkjaer
authors.affiliation: Danish Air Ambulance, Department of Pre-hospital Medical Services, Aarhus N, Denmark.
authors.forename: T M
authors.initials: TM
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Eiskjaer
authors.affiliation: Department of Anaesthesia and Intensive Care, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Christensen
authors.affiliation: Department of Anaesthesia and Intensive Care, Head & Heart Centre, Aarhus University Hospital, Aarhus N, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Gjedsted
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002423:Cause of Death; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies