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首页> 外文期刊>Canadian Journal of Emergency Medicine >A comprehensive regional clinical and educational ECPR protocol decreases time to ECMO in patients with refractory out-of-hospital cardiac arrest
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A comprehensive regional clinical and educational ECPR protocol decreases time to ECMO in patients with refractory out-of-hospital cardiac arrest

机译：全面的区域性临床和教育性ECPR协议可减少难治性院外心脏骤停患者的ECMO时间

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Objective Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE). Methods In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital. We developed clear and reproducible inclusion criteria and processes, including measures of program efficiency. We conducted seminars and teaching modules to paramedics and hospital-based clinicians including monthly simulator sessions, and performed detailed reviews of each treated case in the form of report cards. In this before-and-after study we compared patients with ECPR attempted prior to, and after, protocol implementation. The primary outcome was TTE, defined as the time of initial professional CPR to establishment of extracorporeal circulation. We compared the median TTE for patients in the two groups using the Wilcoxon signed rank test. Results Four patients were identified prior to the protocol and managed in an ad hoc basis; for nine patients the protocol was utilized. Overall favourable neurological outcomes among ECPR-treated patients were 27%. The median TTE was 136 minutes (IQR 98 - 196) in the pre-protocol group, and 60 minutes (IQR 49 - 81) minutes in the protocol group (p=0.0165). Conclusion An organized clinical and educational protocol to initiate ECPR for patients with OHCA is feasible and significantly reduces the key benchmark of time-to-ECPR flows.
机译：目的CPR（ECPR）内的体外膜氧合可以改善难治性院外心脏骤停（OHCA）的存活率。我们制定了院前，急诊科（ED）和基于医院的临床和教育规程，以改善ECPR时间（TTE）的关键变量。方法在一个单一的城市卫生区域，我们在2年的时间内让关键的院前，临床和行政利益相关者参与进来，制定了区域性ECPR计划，并把目的地定在了一个城市三级医疗医院。我们制定了明确且可重复的纳入标准和流程，包括计划效率的衡量标准。我们为护理人员和医院临床医生举办了研讨会和教学模块，包括每月一次的模拟会议，并以报告卡的形式对每个已治疗病例进行了详细审查。在这项前后研究中，我们比较了在实施方案之前和之后尝试进行ECPR的患者。主要结果是TTE，定义为最初的专业心肺复苏术到建立体外循环的时间。我们使用Wilcoxon符号秩和检验比较了两组患者的TTE中位数。结果在方案之前确定了4例患者，并对其进行了临时管理。对于9名患者，使用了方案。经ECPR治疗的患者总体神经功能预后良好，为27％。协议前组中位TTE为136分钟（IQR 98-196），协议组中位TTE为60分钟（IQR 49-81）分钟（p = 0.0165）。结论一项有组织的临床和教育规程对OHCA患者启动ECPR是可行的，并显着降低了ECPR流程的关键基准。

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