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Extrakorporale kardiopulmonale Reanimation (eCPR) bei prähospitalem Herz-Kreislauf-Stillstand (OHCA)

Retrospektive Analyse einer „Load-and-go“-Strategie unter dem Aspekt „golden hour of eCPR“

Extracorporeal cardiopulmonary resuscitation (eCPR) for out-of-hospital cardiac arrest (OHCA)

Retrospective analysis of a load and go strategy under the aspect of golden hour of eCPR

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Zusammenfassung

Hintergrund

Für ausgewählte Patienten mit therapierefraktärem Herz-Kreislauf-Stillstand zeigt sich die extrakorporale kardiopulmonale Reanimation (eCPR) zunehmend als vielversprechende Therapieoption. Retrospektive Kohortenstudien zeigen eine signifikante Verbesserung der Überlebensraten.

Fragestellung

In der vorliegenden Studie wurden Prozesszeiten und die Überlebensrate bei einer „Load-and-go“-Strategie im außerhospitalen Herz-Kreislauf-Stillstand (OHCA) analysiert. Insbesondere sollte geklärt werden, ob „Low-flow“-Zeiten über 60 min als Ausschlusskriterium zur eCPR dienen.

Material und Methoden

In dieser retrospektiven Kohortenstudie wurden die Daten von 32 Patienten mit eCPR nach OHCA zwischen Januar 2017 und September 2019 untersucht. Standardmäßig erfasste demografische Daten sowie prähospitale und klinische Zeitintervalle wurden ermittelt und deren Einfluss auf das Überleben bis zur Krankenhausentlassung analysiert.

Ergebnisse

Im untersuchten Patientenkollektiv ergaben sich eine Überlebensrate von 28 % und ein Überleben mit gutem neurologischen Behandlungsergebnis von 19 % zum Zeitpunkt der Krankenhausentlassung. Zwar zeigen die Überlebenden in der Tendenz schnellere Prozesszeiten, jedoch ohne statistische Signifikanz. Betrachtet man die Low-flow-Zeit aller Patienten, ergibt sich mit einer medianen Low-flow-Zeit von 69 (52–86) min ein Überschreiten des empfohlenen 60-min-Rahmens. Die Gruppen (Überleben vs. Verstorben) zeigten in Bezug auf die Demografie und die Prozesszeiten keinen statistisch signifikanten Unterschied, mit Ausnahme des Patientenalters (47 (30 bis 60) vs. 59 (50 bis 68) Jahre, p = 0,035).

Schlussfolgerung

Trotz des Überschreitens einer empfohlenen Prozesszeit von 60 min bis zum Start einer eCPR konnte im OHCA ein Überleben in 28 % der Fälle erreicht werden. Überschreiten eines fiktiven „cut off“ von 60 min sollte somit kein definitives Ausschlusskriterium für eine eCPR sein.

Abstract

Background

Survival rates after an out-of-hospital cardiac arrest (OHCA) remain low. Extracorporeal cardiopulmonary resuscitation (eCPR) has been introduced as an attempt to increase survival in selected patients and observational studies have shown promising results. Nevertheless, inclusion criteria and timing of eCPR remain undefined.

Objective

The current study analyzed a load and go strategy with respect to the golden hour of eCPR as a cut-off time for survival and favorable neurological outcome.

Material and methods

This retrospective cohort study included 32 patients who underwent eCPR treatment due to an OHCA between January 2017 and September 2019. Routinely taken patient demographic data (age, BMI, sex) were analyzed. The main focus was set on processing times in the preclinical and clinical setting. Time intervals including OHCA until ambulance arrival, time on scene, transportation times and door to eCPR were extracted from emergency medical service (EMS) and resuscitation protocols. Low-flow times, survival and neurological outcome were analyzed.

Results

The use of eCPR in OHCA was associated with survival to hospital discharge in 28% and a good neurological outcome in 19% of the cases. Both groups (survivor and nonsurvivor) did not differ in patient demographics except for age. Survivors were significantly younger (47 (30–60) vs. 59 (50–68) years, p = 0.035). Processing times as well as low-flow times were not significantly different (OHCA-eCPR survivor 64 (50–87) vs. non-survivor 74 (51–85) min; p-value 0.64); however, median low-flow times were outside the golden hour of eCPR (69 (52–86)).

Conclusion

Despite low-flow times of more than 60 min, eCPR was associated with survival in 28% after OHCA. Hence, exceeding the golden hour of eCPR cannot act as a definitive exclusion criterion for eCPR.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ECMO-Zentrum, Klinikum Kassel, Mönchebergstr. 41–43, 34125, Kassel, Deutschland

    Christian Reyher, Sarah R. Karst, Ralf M. Muellenbach, Vincent Boersch & Caroline Rolfes

  2. Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Marburg, Deutschland

    Christian Reyher & Caroline Rolfes

  3. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    Christopher Lotz

  4. Klinik für Herzchirurgie, ECMO-Zentrum, Klinikum Kassel, Kassel, Deutschland

    Asghar A. Peivandi

  5. Interdisziplinäre Zentrale Notaufnahme, Klinikum Kassel, Kassel, Deutschland

    Klaus Weber

  6. Klinik für Kardiologie, Klinikum Kassel, Kassel, Deutschland

    Rainer Gradaus

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  1. Christian Reyher
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  6. Vincent Boersch
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  7. Klaus Weber
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  9. Caroline Rolfes
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Correspondence to Christian Reyher.

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Interessenkonflikt

C. Reyher, S.R. Karst, R.M. Muellenbach, C. Lotz, A.A. Peivandi, V. Boersch, K. Weber, R. Gradaus und C. Rolfes geben an, dass kein Interessenkonflikt besteht.

Diese retrospektive Studie erfolgte nach Konsultation der zuständigen Ethikkommission und im Einklang mit nationalem Recht.

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Reyher, C., Karst, S.R., Muellenbach, R.M. et al. Extrakorporale kardiopulmonale Reanimation (eCPR) bei prähospitalem Herz-Kreislauf-Stillstand (OHCA). Anaesthesist 70, 376–382 (2021). https://doi.org/10.1007/s00101-020-00896-2

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  • DOI: https://doi.org/10.1007/s00101-020-00896-2

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