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Exploring crucial time factors and pre-hospital chain performance in eCPR/uDCDD program candidates : a prospective observational analysis
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Introdução: A Ressuscitação Cardiopulmonar Extracorporal, eCPR, é um procedimento complexo, tempo-dependente, utilizado em doentes selecionados que sofrem uma Paragem Cardiorrespiratória Refratária (PCRr). Para melhorar a sua acessibilidade, é essencial compreender os atrasos que ocorrem entre a PCRr e a admissão hospitalar.
Métodos: Um estudo prospetivo observacional foi realizado em pacientes selecionados num hospital universitário. Os pacientes elegíveis tinham mais de 18 anos, sofreram uma PCRr fora-do-hospital potencialmente reversível com um tempo No-Flow inferior a 15 minutos. Posteriormente, foram tratados segundo um protocolo institucional de eCPR/DCP pré-especificado. O objetivo primário foi caracterizar os tempos entre a PCRr e o início da eCPR. Os objetivos secundários foram correlacionar os resultados com a sobrevivência às 24 horas, a alta do SMI e hospitalar e evidenciar a relevância do Suporte Básico de Vida (SBV).
Resultados: 31 pacientes foram incluídos. 80.65% eram homens e a idade média foram 50.6 anos (±11.1). 8 foram incluídos no ramo da eCPR, 12 no da DCP, 3 recuperaram e 8 foram declarados mortos. 28 das PCRr foram presenciadas e destas 12 receberam SBV. O tempo No-Flow 1 foi de 0 minutos (IIQ 0-5), o tempo até o primeiro contracto com o SMI foi de 17 minutos (IIQ 11-24), o tempo PRCr - Admissão hospitalar foi de 60 minutos (IIQ 42-70), o tempo Low-Flow foi de 80 minutos (IIQ 60-109) e o tempo total PCRr - eCPR foi de 83.5 minutos (IIQ 56-107). 75% dos pacientes foram excluídos da eCPR devido a critérios de tempo.
Conclusão: Reduzir o tempo pré-hospitalar é crucial para melhorar a sobrevivência e a acessibilidade à eCPR, uma vez que o tempo total entre a PCRr e o início da eCPR excede as recomendações. A rápida tomada de decisão e mobilização dos pacientes são essenciais. O SBV desempenha um papel essencial na cadeia de sobrevivência e deve ser universalizado.
Introduction: Daily, around 1000 individuals across Europe experience an Out-of-Hospital Cardiac Arrest (OHCA) with a mortality rate of 90%. Extracorporeal Cardiopulmonary Resuscitation (eCPR) is a time-sensitive and complex procedure for selected patients suffering a Refractory Cardiac Arrest (rCA). To improve accessibility to eCPR and optimize survival, all rate-limiting steps between an OHCA and hospital arrival must be analyzed. Methods: A prospective observational study was conducted on selected patients in a university hospital. Eligible patients were over 18 years old, had an OHCA with a plausible reversible cause and a No-Flow time lower than 15 minutes. Patients were treated according to a prespecified institutional eCPR/uDCDD program. The primary objective was to characterize specific time-points between OHCA and ECMO retrieval. The secondary objectives were to correlate those variables with survival at 24 hours, ICU and hospital discharge and to underline bystander CPR’s relevance and possible impact on outcomes. Results: 31 patients were included, 80.65% were male and the average age was 50.6 (± 11.1) years. 8 were included in the eCPR branch, 12 in the uDCDD branch, 3 had ROSC and 8 were pronounced dead. 28 patients had a witnessed rCA and of these12 received CPR. No-Flow time 1 was 0 minutes (IQR 0-5), Time to first ICU contact was 17 minutes (IQR 11-24), Time from OHCA to hospital admission was 60 minutes (IQR 42-70), Low-Flow time was 80 minutes (IQR 60-109), and total time between OHCA and eCPR initiation was 83.5 minutes (IQR 56-107). 75% of excluded patients from the eCPR branch were due to time-related criteria. Conclusion: Reducing pre-hospital time is crucial for eCPR accessibility and survival improvement, as the total time between OHCA and eCPR initiation exceeds recommendations. Rapid decision-making and prompt patient mobilization to the hospital are imperative. CPR's essential role in the survival chain necessitates universal implementation efforts.
Introduction: Daily, around 1000 individuals across Europe experience an Out-of-Hospital Cardiac Arrest (OHCA) with a mortality rate of 90%. Extracorporeal Cardiopulmonary Resuscitation (eCPR) is a time-sensitive and complex procedure for selected patients suffering a Refractory Cardiac Arrest (rCA). To improve accessibility to eCPR and optimize survival, all rate-limiting steps between an OHCA and hospital arrival must be analyzed. Methods: A prospective observational study was conducted on selected patients in a university hospital. Eligible patients were over 18 years old, had an OHCA with a plausible reversible cause and a No-Flow time lower than 15 minutes. Patients were treated according to a prespecified institutional eCPR/uDCDD program. The primary objective was to characterize specific time-points between OHCA and ECMO retrieval. The secondary objectives were to correlate those variables with survival at 24 hours, ICU and hospital discharge and to underline bystander CPR’s relevance and possible impact on outcomes. Results: 31 patients were included, 80.65% were male and the average age was 50.6 (± 11.1) years. 8 were included in the eCPR branch, 12 in the uDCDD branch, 3 had ROSC and 8 were pronounced dead. 28 patients had a witnessed rCA and of these12 received CPR. No-Flow time 1 was 0 minutes (IQR 0-5), Time to first ICU contact was 17 minutes (IQR 11-24), Time from OHCA to hospital admission was 60 minutes (IQR 42-70), Low-Flow time was 80 minutes (IQR 60-109), and total time between OHCA and eCPR initiation was 83.5 minutes (IQR 56-107). 75% of excluded patients from the eCPR branch were due to time-related criteria. Conclusion: Reducing pre-hospital time is crucial for eCPR accessibility and survival improvement, as the total time between OHCA and eCPR initiation exceeds recommendations. Rapid decision-making and prompt patient mobilization to the hospital are imperative. CPR's essential role in the survival chain necessitates universal implementation efforts.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Ressuscitação cardiopulmonar extracorporal Paragem cardiorrespiratória refratária Paragem cardiorrespiratória fora-do-hospital Tempo-dependente Suporte básico de vida