Lactate in refractory #OHCA: post-hoc analysis of Prague OHCA Study
⏱️ early lactate levels (measured anytime during first 24 h after admission) correlate with outcome of patients undergoing #ECPR
🧪 lactate > 14 mmol/L on admission predicts unfavourable outcome of #ECMO patients
🚑 if prehospital ROSC, unfavourable outcome likely if lactate > 10.8 mmol/L
🧪 single measurement? not enough for reliable outcome prediction
🖇️ https://bit.ly/3QB7cUl

🫀 Prevalence, reasons, timing of decisions to withhold/withdraw life‑sustaining therapy for out‑of‑hospital cardiac arrest pts on #ECPR, secondary analysis of SAVE-J II multicenter Japan 🇯🇵 study:
🏥 WLST occurred in about ⅓ of #OHCA patients on #ECMO in this nationwide cohort
🧠 main reason for WLST: perceived unfavorable neurological prognosis
⏳ decision for WLST made early, at a median of 2 days after ICU admission: a time when neuro-prognostication is not recommended
🖇️ https://rdcu.be/dfL8g

🚑 If the patient cannot be taken to #ECPR in time, maybe ECPR should be taken to pt?? Although many questions still to be answered, low-flow time major prognostic factor for neuro intact survival. Despite major efforts made to bring pts to the hospital within acceptable timing, this objective can often not be filled.
🖇️ https://rebrand.ly/bfc2f7

🚑 Refers to predictive modelling study on potential benefit of pre-hospital ECPR in patients with #OHCA in the Netherlands.
🖇️ https://rebrand.ly/3e18e7

Do NOT miss #ECPR session at #SEECMO2023 annual Specialist Education in #ECMO Conference, hosted by University of Florida & supported by ELSO
🫀out-of-hospital cardiac arrest #OHCA, Jan Belohlavek
🫀Dutch experience, Xavier Moors
🫀pediatric #PedsICU, Tom Brogan
🫀community, Alejandra Gutierrez
🎤 moderated by Xavier Moors & Anton Becker
🗓️ May 19-21 2023
🗺️ Gainesville FL
🖋️ seecmo2023.cme.ufl.edu

🎥 https://bit.ly/41AqGKV

Do NOT miss #ECPR session at #SEECMO2023 annual Specialist Education in #ECMO Conference, hosted by University of Florida & supported by ELSO
🫀out-of-hospital cardiac arrest #OHCA, Jan Belohlavek
🫀Dutch experience, Xavier Moors
🫀pediatric #PedsICU, Tom Brogan
🫀community, Alejandra Gutierrez
🎤 moderated by Xavier Moors & Anton Becker
🗓️ May 19-21 2023
🗺️ Gainesville FL
🖋️ seecmo2023.cme.ufl.edu

🎥 https://bit.ly/41AqGKV

🫀 Airway management strategies during #ACLS in patients with refractory out-of-hospital cardiac arrest #OHCA presenting for #ECLS: study of University of Minnesota ECPR program. In pts receiving prolonged CPR, endotracheal intubation as primary airway strategy associated with improved oxygenation & ventilation at time of evaluation for VA #ECMO vs supraglottic airways. This resulted in increased rate of candidacy for ECPR and increased neurologically favorable survival.
🖇️ http://bit.ly/3n9abXa

Precannulation cerebral rSO2, able to predict #ECPR survival & outcome??: Systematic Review and Meta-Analysis including both in-hospital and out-of-hospital cardiac arrest patients undergoing #ECLS. High precannulation rSO2 in overall population and in #OHCA patients associated with:
🫀overall reduced risk of mortality
🧠 significantly better neurologic outcome
A low rSO2 before starting #ECMO support could be a predictor of mortality and survival with poor neuro-outcome.
🖇️ http://bit.ly/3Z4wtXV

Early extracorporeal CPR vs conventional CPR (standard ACLS) for refractory out-of-hospital cardiac arrest caused by an initial ventricular arrhythmia, results ofINCEPTION 🇳🇱 multicenter RCT published on The New England Journal of Medicine
🖇️ https://bit.ly/3JgV1YY
Coming with quick take video and editorial, #OHCA, still on life support??
🖇️ https://bit.ly/3WNm0Pe

Early extracorporeal CPR vs conventional CPR (standard ACLS) for refractory out-of-hospital cardiac arrest caused by an initial ventricular arrhythmia, INCEPTION 🇳🇱 multicenter RCT
🫀 134 pts experiencing #OHCA, 70 assigned to #ECPR, 64 #cCPR
📈 similar effects on survival with favorable neuro outcome
📈 similar serious adverse events
Any thoughts on these results, just out on NEJM?? I have a lot...
🖇️ https://bit.ly/3JgV1YY

With editorial, #OHCA, still on life support??
🖇️ https://bit.ly/3WNm0Pe

Debriefing should be the last step to every ALS algorithm

And ask the question “is a cold debrief needed”

Give the opportunity for patient follow up too

#debriefing #colddebrief #hotdebrief #OHCA #cardiacarrest #trauma #wellbeing

Ongoing #ECMO? NOT a barrier to organ donation!
⛔️ #ECLS vs non-ECLS patients: similar rate of recovered but not transplanted organs
❤️ 51% DCD 🧠 49% DND = both suitable paths to donation in this population
❤️ 39% of donors had #OHCA, 51% underwent #ECPR: events and procedures associated with high morbidity do not preclude successful donation
Consideration of patients on ECMO for organ donation can provide a benefit to families, as well as to potential organ recipients.
📖 https://bit.ly/3VsEmnE

🚑 How to improve access to #ECMO for #OHCA? Mobile teams might contribute more than in-hospital #ECLS: pre-hospital #ECPR seems offering the most benefit, but other delivery approaches as rendezvous strategy might presents advantages worth exploring.
#FOAMcc
📖 https://rdcu.be/c2hzA

A second chance for survival, #ECPR in refractory #OHCA:
🫀contemporary (compelling) RCT evidence supporting #ECMO for highly selected patients (specifically, initially shockable rhythms, witnessed arrests, and presumed cardiac etiology
🫀eligibility
🚑 prehospital system design: load & go vs prioritizing prehospital resuscitation
🏥 critical care management & resource need
🏥 case volumes, team experience, ECPR access
💰cost effectiveness and barriers to implementation
🖇️ https://bit.ly/3V7649E