The incidence of load&go out-of-hospital cardiac arrest candidates for emergency department utilization of emergency extracorporeal life support: A one-year review

Background: The outcome of patients after out-of-hospital cardiac arrest (OHCA) is poor and gets worse after prolonged resuscitation. Recently introduced attempts like an early installed emergency extracorporeal life support (E-ECLS) in patients with persisting cardiac arrest at the emergency department (ED) are tried. The Vienna Cardiac Arrest Registry (VICAR) was introduced August 2013 to collect Utstein-style data. The aim of this observational study was to identify the incidence of patients which fulfil load&go-criteria for E-ECLS at the ED. Methods: VICAR was retrospectively analyzed for following criteria: age < 75 years; witnessed OHCA; basic life support; ventricular fibrillation/ventricular tachycardia; no return-of-spontaneous-circulation (ROSC) within 15 min of advanced-life-support, which were supposed as potential optimal criteria for load&go plus successful E-ECLS treatment at the ED. The observation period was from August 1, 2013 to July 31, 2014. Results: Over 948 OHCA patients registered during the study period; data were exploitable for 864 patients. Of all patients, load&go-criteria were fulfilled by 55 (6%). However, 96 (11%) were transported with on-going CPR to the ED. Of these 96 patients, only 16 (17%) met the load&go-criteria. Similarly, among the 96 patients, 12 adults were treated with E-ECLS at the ED, with only 5 meeting the criteria. Among these 12 patients, favourable neurological outcome (CPC 1/2) was obtained in 1 patient without criteria. Conclusion: Further promotion of these criteria within the ambulance crews is needed. May be these criteria could serve as a decision support for emergency physicians/paramedics, which patients to transport with on-going CPR to the ED for E-ECLS. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.