P099: Evaluating the potential impact of an ECPR program at The Ottawa Hospital: a retrospective health records review

Abstract

Introduction: Extracorporeal Life Support in the context of cardiac arrest (ECPR) is an emerging resuscitative therapy which has shown promising results for patients who may not otherwise survive. As a resource-intensive intervention, ECPR requires carefully selected patients to maximize its potential benefits and mitigate undue harm. This retrospective health records review sought to identify the characteristics of cardiac arrest patients presenting to two academic tertiary care Emergency Departments (EDs) in order to assess the feasibility and impact of an ECPR program. Methods: We reviewed charts for all patients aged 18-75 years old presenting to two Academic Teaching Hospitals with out-of-hospital or in-ED refractory cardiac arrest from January 2015 to December 2016. Based on a review of existing ECPR literature, we defined two sets of liberal and restrictive criteria associated with survival and applied these to our cohort for possible initiation of ECPR. The chart review was completed by one of the principal investigators, with 10% of charts randomly reviewed by a second investigator to ensure good inter-agreement. Any discrepancies or ambiguities found in the review were resolved collaboratively between both investigators. Results: A total of 220 charts were identified and 191 deemed eligible for inclusion in the study. The median age was 59 (IQR: 49.5-67) years and the cohort was 72% male. The initial presenting rhythm was identified as VT/VF in 47% of patients. 65% of arrests were witnessed, with immediate bystander CPR performed on 50% patients and an additional 12% receiving CPR within 10 minutes of collapse. 60% of patients had cardiac arrest lasting less than 75 minutes. 69% of patients were identified as having a reversible cause of cardiac arrest. A favorable premorbid status was identified in 76% of patients. Application of our two sets of ECPR inclusion criteria revealed that 17% and 3% of patients for the liberal and restrictive criteria respectively, would have been candidates for ECPR. Conclusion: At our centre, we identified that in a two-year period, 3% to 17% of cardiac arrest patients presenting to the ED would have met inclusion criteria for ECPR, translating to an additional 0.2-1.4 patients per month admitted for critical care. These findings would suggest that the implementation of an ECPR program at our institution has the potential to have a positive impact for patients with only a relatively low volume of patients requiring additional resources.