TY - JOUR
T1 - The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation
T2 - Program description, performance, and outcomes
AU - Bartos, Jason A.
AU - Frascone, R. J.
AU - Conterato, Marc
AU - Wesley, Keith
AU - Lick, Charles
AU - Sipprell, Kevin
AU - Vuljaj, Nik
AU - Burnett, Aaron
AU - Peterson, Bjorn K.
AU - Simpson, Nicholas
AU - Ham, Kealy
AU - Bruen, Charles
AU - Woster, Casey
AU - Haley, Kari B.
AU - Moore, Joanna
AU - Trigger, Brandon
AU - Hodgson, Lucinda
AU - Harkins, Kim
AU - Kosmopoulos, Marinos
AU - Aufderheide, Tom P.
AU - Tolar, Jakub
AU - Yannopoulos, Demetris
N1 - Funding Information:
All authors report having received funding from the Leona M. and Harry B. Helmsley Charitable Trust. JAB, TPA, and DY also received funding from the National Heart, Lung, and Blood Institute.
Funding Information:
Project funding was received from the Helmsley Charitable Trust. JAB, TPA, and DY also received funding from the National Heart, Lung, and Blood Institute.
Publisher Copyright:
© 2020 The Authors
PY - 2020/12
Y1 - 2020/12
N2 - Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). Methods: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18–75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit. Findings: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31–56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2. Interpretation: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities.
AB - Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). Methods: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18–75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit. Findings: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31–56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2. Interpretation: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities.
KW - Cardiac arrest
KW - Extracorporeal cardiopulmonary resuscitation
KW - Extracorporeal membrane oxygenation
KW - Refractory ventricular fibrillation
KW - Sudden cardiac death
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UR - http://www.scopus.com/inward/citedby.url?scp=85097134543&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2020.100632
DO - 10.1016/j.eclinm.2020.100632
M3 - Article
C2 - 33437949
AN - SCOPUS:85097134543
SN - 2589-5370
VL - 29-30
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 100632
ER -