ECMO improves survival in patients suffering from refractory cardiac arrest

Val d’Hebron showed that extracorporeal membrane oxygenation (ECMO) improves survival in patients suffering from refractory cardiac arrest. This study, published in the journal of the Spanish Society of Intensive Care and Coronary Care (SEMICYUC), shows good results from the implementation of an extracorporeal cardiopulmonary resuscitation (ECPR) program at the Vall d’Hebron University Hospital. this serves as a benchmark for the use of this technology at the level of international reference centers.

ECMO is an advanced life support technique that temporarily replaces the function of the heart and lungs when they cannot function on their own. In a cardiac arrest situation where traditional methods such as chest compressions and defibrillation are unable to restore the heartbeat, ECMO is used to oxygenate blood outside the body and return it to the patient. In this way, circulation is restored so that the cardiac arrest can be treated and the affected organs have time to recover: this is called extracorporeal cardiopulmonary resuscitation (ECPR), which allows us to offer survival options to patients who would not otherwise do so. I don’t have them.

The Val d’Hebron team analyzed the results of the ECPR program between January 2019 and April 2023. During this period, it was applied to 54 adult patients being treated in hospital. Of these, 29 had cardiac arrest outside the hospital, and 25 in the hospital. The most common cause in more than half of the cases was acute myocardial infarction. The development of patients was monitored for 180 days.

The work shows that 16 patients (29.6%) lived to 180 years after the intervention, 15 of them had a complete neurological recovery without consequences. “Our results are similar to those obtained by other international reference centers using this technique. In summary, we demonstrate that the ECPR program in Val d’Hebrone improves survival and offers treatment options for patients in whom cardiac recovery is not possible. using traditional resuscitation methods and who had no other alternative to survive”declares Dr. Edward Argudo, Deputy Intensive Care Service, ECPR Specialist at the University Hospital Val d’Hebron and Principal Investigator of the Shock, Organic Dysfunction and VHIR Resuscitation Group.

“The cardiology service also plays a fundamental role in the management of these patients, as the most common cause of cardiopulmonary arrest is cardiovascular. In this sense, comprehensive work is needed, involving the interaction of various departments of the service (hemodynamics, arrhythmias and arrhythmias). , imaging, intensive cardiovascular therapy) for correct diagnosis and treatment,” confirms Dr. Maria Vidal Burdeus, Member of the Cardiology Service of the University Hospital Val d’Hebron and Researcher of the Cardiovascular Group of the VHIR.

EMS coordination is essential to enable ECPR to be performed in out-of-hospital cases.

At the community level, the Catalan Emergency Medical System (SEM) is a key factor in identifying such patients, starting cardiopulmonary resuscitation in the first minutes and transferring them to high-volume centers. In this case, the role of the Health Coordination Center and SEM assistance teams is fundamental. “Since the first ECMO patient transfer occurred in August 2016, we have recognized the need to deepen ECMO therapy as part of CPR processes in our environment, with centers with a strong program and capacity to accommodate patients who could benefit from it. technique”explains Dr. Jorge Morales, Medical Director of SEM and one of the authors of the study.

For all these reasons, patients who were considered to meet the criteria for CPR were initially referred until a positive synergy was established between the Vall d’Hebron University Hospital and the ambulance service, indicating the beginnings of an ECMO CPR program that began in Catalonia. in October 2023.

Ambulance is the basis of coordination that enables the implementation of the community-based ECRP program. “The results of this study are promising for patients who, until recently, had no alternative to life,” adds Dr. Morales.

Speed ​​of ECMO initiation and electrical rhythm of the heart influence survival

When it came to understanding the factors influencing the survival of patients receiving this support, the study found that patients who had their arrest in hospital had a slightly higher survival rate (36%) compared to patients who had their arrest outside of hospital ( 24.1). %). These results highlight the importance of prompt initiation of ECMO to restore blood flow and improve the chances of survival. It is therefore essential to have, as the Val d’Hebron hospital has, a team of ECMO experts with extensive experience and training, as well as coordination between hospitals and the emergency medical system to further improve outcomes even in out-of-hospital settings. cases.

The study also looked at results based on heart rate at the time of the stop. Patients who had a heart rhythm requiring defibrillation (ventricular fibrillation or ventricular tachycardia) had better survival outcomes. 33.3% of these patients survived with good neurological outcome at 180 days. In contrast, patients with non-shock heart rhythms had lower survival rates at 21.2%.

New opportunity for organ donation

In addition to directly improving survival and quality of life for patients, the ECPR program in Val d’Hebron has had a positive impact on organ donation. The study found that of patients who received ELR and did not survive, 30.3% were organ donors. “These data highlight the added value of ECPR, which not only saves lives in critical situations, but also makes a significant contribution to organ donation, offering a second chance to others.”adds Dr. Argudo.