Grunau Brian, Shemie Sam D, Wilson Lindsay C, Dainty Katie N, Nagpal Dave, Hornby Laura, Lamarche Yoan, van Diepen Sean, Kanji Hussein D, Gould James, Saczkowski Richard, Brooks Steven C
Department of Emergency Medicine and Centre for Health Evaluation and Outcome Sciences, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.
Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada.
CJC Open. 2020 Nov 13;3(3):327-336. doi: 10.1016/j.cjco.2020.11.005. eCollection 2021 Mar.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a therapeutic option for refractory cardiac arrest. We sought to perform an environmental scan to describe ECPR utilization in Canada and perceived barriers for application to out-of-hospital cardiac arrest (OHCA).
This was a national cross-sectional study. We identified all cardiovascular surgery- and extracorporeal membrane oxygenation (ECMO)-capable hospitals in Canada and emergency medical services (EMS) agencies delivering patients to those centres. We requested the medical lead from each hospital's ECMO service and each EMS agency to submit data regarding ECMO and ECPR utilization, as well as perceived barriers to ECPR provision for OHCA.
We identified and received survey data from 39 of 39 Canadian hospital institutions and 21 of 22 EMS agencies. Of hospitals, 38 (97%) perform ECMO and 27 (69%) perform ECPR (74% of which perform ≤5 cases per year). Of the 18 (46%) sites offering ECPR for OHCA, 8 apply a formal protocol for eligibility and initiation procedures. EMS agencies demonstrate heterogeneity with intra-arrest transport practices. The primary rationale for nontransport of refractory OHCA is that hospital-based care offers no additional therapies. Perceived barriers to the use of ECPR for OHCA were primarily related to limited evidence supporting its use, rather than resources required.
Many Canadian cardiovascular surgery- or ECMO-equipped hospitals use ECPR; roughly half employ ECPR for OHCAs. Low case volumes and few formal protocols indicate that this is not a standardized therapy option in most centres. Increased application may be dependent on a stronger evidence base including data from randomized clinical trials currently underway.
体外心肺复苏（ECPR）是治疗难治性心脏骤停的一种选择。我们试图进行一项环境扫描，以描述加拿大ECPR的使用情况以及应用于院外心脏骤停（OHCA）时所感知到的障碍。
这是一项全国性横断面研究。我们确定了加拿大所有具备心血管手术和体外膜肺氧合（ECMO）能力的医院以及将患者送至这些中心的紧急医疗服务（EMS）机构。我们要求每家医院的ECMO服务部门负责人和每个EMS机构提交有关ECMO和ECPR使用情况的数据，以及为OHCA提供ECPR时所感知到的障碍。
我们从39家加拿大医院机构中的39家以及22家EMS机构中的21家获取并收到了调查数据。在医院中，38家（97%）开展ECMO，27家（69%）开展ECPR（其中74%每年开展的病例数≤5例）。在为OHCA提供ECPR的18家（46%）机构中，8家采用正式的资格认定和启动程序方案。EMS机构在心脏骤停期间的转运做法上存在异质性。难治性OHCA不转运的主要理由是基于医院的治疗没有额外的疗法。OHCA使用ECPR所感知到的障碍主要与支持其使用的证据有限有关，而非所需资源。
许多配备了心血管手术或ECMO的加拿大医院使用ECPR；约一半的医院将ECPR用于OHCA。病例数少且正式方案少表明，在大多数中心这不是一种标准化的治疗选择。应用的增加可能依赖于更强有力的证据基础，包括来自正在进行的随机临床试验的数据。
