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Extracorporeal cardiopulmonary resuscitation in a large tertiary center in the Czech Republic: three years'
Filip Burša1,2, Michal Frelich3, Peter Sklienka1,2
1Department of Anesthetics, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, 17. Listopadu 1790, Ostrava, 708 00, Czech Republic.
Insights
Extracorporeal resuscitation (ECPR) offers improved survival and neurological outcomes for out-of-hospital cardiac arrest (OHCA) patients. This study demonstrates favorable results comparable to established centers, with good long-term quality of life.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) improves outcomes in out-of-hospital cardiac arrest (OHCA) but is not standard care.
- Establishing new ECPR centers is challenging; lessons from experienced centers are valuable.
- This study assesses survival and neurological outcomes of ECPR.
Purpose of the Study:
- To assess survival rates and neurological outcomes after ECPR.
- To evaluate peri-ECPR parameters in relation to neurological outcomes.
- To describe long-term quality of life six months after ECPR.
Main Methods:
- Monocentric study of refractory OHCA patients undergoing ECPR at University Hospital Ostrava (2022-2024).
- Data collected from the Ostrava ECMO Centre registry.
- Long-term outcomes assessed using SF36, EQ-5D-5L, and HADS questionnaires.
Main Results:
- 74 patients included; 93% cannulation success rate.
- Median collapse-to-ECMO interval was 75 minutes.
- 39.1% survival to ICU discharge, 27.5% discharged home, 33.3% survival at 6 months.
- 29% had good neurological outcome (CPC 1-2) at Day 30.
- Patients reported low pain, anxiety, depression; median QALY/year was 0.90.
Conclusions:
- ECPR program outcomes in Ostrava are comparable to established centers.
- Favorable results achieved despite a 75-minute collapse-to-ECMO interval.
- Good overall quality of life reported by patients six months post-arrest.
Background:
Extracorporeal resuscitation (ECPR) has been shown to improve outcomes in out-of-hospital cardiac arrest (OHCA). It is, however, not the standard of care. The establishment of new ECPR centers is challenging, even though valuable lessons can be learned from more experienced centers. The primary objective of this study was to assess survival rates and neurological outcomes after ECPR. The secondary objective is to evaluate peri-ECPR parameters in relation to neurological outcomes, and to describe the long-term quality of life six months after ECPR.
Methods:
This monocentric study involves patients with refractory OHCA transported to the hospital with ongoing mechanical cardiopulmonary resuscitation (CPR) for ECPR implementation at the extracorporeal membrane oxygenation (ECMO) Center of the University Hospital Ostrava, Czech Republic, from 1 January 2022 until the end of 2024. Outcome was assessed through analysis of data from the Ostrava ECMO Centre registry and long-term outcomes were evaluated using the SF36, EQ-5D-5L, and HADS questionnaires as retrospective study. The indication criteria and care standards were followed according to a local protocol.
Results:
Over three years, 74 patients met the inclusion criteria for ECPR, with a cannulation success rate exceeding 93%. The median collapse-to-ECMO interval was 75 min. The survival to discharge from the intensive care unit was 39.1%, with 27.5% of patients discharged home and 33.3% survival after 6 months. Good neurologic outcome (cerebral performance category, CPC 1-2) on Day 30 post-arrest was observed in 29%. Overall, patients reported only low levels of pain, anxiety, and depression at 6 months post-arrest. The majority were completely self-sufficient, experiencing only minor problems with mobility or usual activities, with a median Quality-Adjusted Life Year/year of 0.90.
Conclusion:
The outcomes of the ECPR program in Ostrava are comparable with long-standing ECPR centers. Considering the interval collapse to ECMO was 75 min, the results were favorable, with good overall quality of life.
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