Improving quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project

Improving quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project

Background Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.Methods A...

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Main Authors: Michael Taylor, Vasileios Panoulas, Jill Smith, Alex Rosenberg, Mark Mason, Ian McGovern, Majid Akhtar, Sachin Mehta, Waqas Akhtar, Anthony McKay, Sumesh Thiruthalil, Orinta Kviatkovske, Donna Hall, Eftychia Galiatsou, Sofia Pinto, Maria Comanici, Emanuele Gerlando, Timothy Pitt, Joe Hughes, Olaf Maunz, Elia Keating, Julia Gangata, Eleanor Ross, Sophie Avetoom, Jane Durrant, Ciara Collins, Anand Jothidasan, Maria Monteagudo-Vela, Jerry Mitchell, Hatem Soliman Aboumarie, Caroline Bullen, Sundeep Kaul, Clara Hernandez Caballero, Ana Hurtado, Nick Lees
Format: Article
Language:English
Published: BMJ Publishing Group 2025-02-01
Series:BMJ Open Quality
Online Access:https://bmjopenquality.bmj.com/content/14/1/e002934.full
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Summary:Background Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.Methods A retrospective analysis was performed of all ECPR cases at Harefield Hospital between April 2018 and April 2023. A new structured system including a systematic screening process, strict exclusion criteria, assessment of resuscitation adequacy through physiological stop criteria, drilled and standardised cannulation process, post-resuscitation care and neuroprognostication was rolled out on 1 April 2023. A comparison of ECPR performed pre and post was undertaken.Results With the institution of the new system, 13 patients were treated with ECPR over 1 year; of which nine (69.2%) survived with good neurological outcomes at 6 months. In the preceding 3 years, there had been 22 cases; of which, two survived (9.1%). This was a statistically significant higher survival with HR of 4.56 (CI 2.1, 10.2, p<0.05).The average length of hospital stay in the new system was 61.3 days; of which, 32.4 days were in the intensive care unit.Conclusions This study shows that it is possible to significantly improve outcomes in ECPR in a single centre by introducing into standard practice, a high-quality bundle of care.
ISSN:2399-6641

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