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| Name | Class |
|---|---|
| Emergency Medical Services, Moravian-Silesian Region | UNKNOWN |
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On-scene extracorporeal pulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) seems to speed up the start of extracorporeal membrane oxygenation (ECMO) and shorten low flow during cardiopulmonary resuscitation (CPR) in case of refractory cardiac arrest. The primary goal is to verify the benefit of on-scene ECPR in terms of shortening the collapse-to-ECMO interval. The secondary goal is to compare outcomes in the on-scene ECPR group with hospital cannulation.
ECPR is a life-saving method for a selected group of patients who are refractory to standard resuscitation procedures. With the appropriate use of ECPR, it is possible to achieve a significant improvement in survival with good neurological outcomes even in patients who would otherwise die. The ECMO Centre Ostrava has been providing ECPR for OHCA since 2022 with cannulation in the hospital after prior transport from the scene under continuous resuscitation. A good neurological outcome is achieved in approximately 29% of patients, even though the collapse-ECMO interval is around 75 minutes. Shortening this interval, which is associated with improved outcomes, is possible by using a mobile team that per-forms cannulation directly on scene. Mobile ECPR will be carried out in cooperation with the Ostrava University Hospital and the Moravian-Silesian Region Emergency Medical Service. The primary objective is to verify the benefit of on-scene ECPR in terms of shortening the collapse-ECMO interval. The secondary objective is to compare the outcome in the on-scene ECPR group with hospital cannulation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ECPR on scene | Experimental | On-scene ECPR cannulation by mobile ECMO team according to protocol if the location of the arrest and circumstances appear to be suitable (distance from the ECMO centre, transport logistics, in an ambulance/at home, etc.) |
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| ECPR in hospital | Active Comparator | Hospital ECPR cannulation at Emergency Department by ECMO team accord-ing to protocol if a on scene ECPR call-out was not indicated. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prehospital ECMO cannulation on scene of cardiac arrest | Procedure | ECPR (Extracorporeal Cardiopulmonary Resuscitation) is a critical, advanced resuscitation technique using Veno-arterial Extracorporeal Membrane Oxygenation for patients in cardiac arrest where conventional CPR fails, functioning as a bridge to restore circulation and oxygenation by pumping and oxygenating blood outside the body before returning it. |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital survival | Hospital survival will be assessed 30 days after the cardiac arrest | 30 days after the cardiac arrest |
| ICU stay | The length of the Intensive Care Unit (ICU) stay will be assessed in days. | Through the ICU stay, on average 12 days |
| Neurologic outcomes | Neurologic outcomes will be assessed in patients using the Cerebral Performance Category (CPC) score. The CPC score is a 1-to-5 scale assessing neurological outcome, most commonly after cardiac arrest, where 1 is best (normal brain function) and 5 is worst (brain death). | 30 days after the cardiac arrest |
| Measure | Description | Time Frame |
|---|---|---|
| Collapse to ECMO interval | The interval from the collapse (cardiac arrest) to ECMO initiation will be measured in minutes. | One hour |
| Collapse to ECMO interval | The interval from the collapse (cardiac arrest) to ECMO initiation will be measured in minutes. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jiří Hynčica | Contact | +42059737 | 2587 | jiri.hyncica@fno.cz |
| Name | Affiliation | Role |
|---|---|---|
| Filip Burša, MD, PhD, EDEC | University Hospital Ostrava | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emergency Medical Services, Moravian-Silesian Region | Recruiting | Ostrava | Moravian-Silesian Region | 700 30 | Czechia |
There is no plan to make individual participant data available to other researchers. The data may be provided upon reasonable request.
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| ID | Term |
|---|---|
| D006323 | Heart Arrest |
| D012770 | Shock, Cardiogenic |
| D058687 | Out-of-Hospital Cardiac Arrest |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D009203 | Myocardial Infarction |
| D017202 | Myocardial Ischemia |
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| ID | Term |
|---|---|
| D036801 | Parturition |
| ID | Term |
|---|---|
| D011247 | Pregnancy |
| D012098 | Reproduction |
| D055703 | Reproductive Physiological Phenomena |
| D012101 | Reproductive and Urinary Physiological Phenomena |
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The study subjects will be enrolled in two parallel arms
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No masking will be used in the study.
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|
| Transfer with ongoing mechanical chest compression to hospital followed by hospital ECMO cannulation | Procedure | ECPR (Extracorporeal Cardiopulmonary Resuscitation) is a critical, advanced resuscitation technique using Veno-arterial Extracorporeal Membrane Oxygenation for patients in cardiac arrest where conventional CPR fails, functioning as a bridge to restore circulation and oxygenation by pumping and oxygenating blood outside the body before returning it. |
|
| From the collapse (cardiac arrest) to ECMO initiation |
| Long-term outcome - Survival | The long-term survival of patients will be assessed 6 months after the collapse. | 6 months after the collapse |
| Long-term outcome - Quality of Life | Long-term quality of life will be assessed 6 months after the collapse using standardised tools (questionnaires). | 6 months after the collapse |
| University Hospital Ostrava | Recruiting | Ostrava | Moravian-Silesian Region | 708 52 | Czechia |
|
| D014652 |
| Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
| D012769 | Shock |