Minnesota Resuscitation Consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation

Demetri Yannopoulos, Jason A Bartos, Cindy M Martin, Ganesh Raveendran, Emil Missov, Marc Conterato, Ralph Frascone, Alexander Trembley, Kevin Sipprell, Ranjit John, Stephen A George, Kathleen P Carlson, Melissa E Brunsvold, Santiago Garcia, Tom P. Aufderheide

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background--In 2015, the Minnesota Resuscitation Consortium (MRC) implemented an advanced perfusion and reperfusion life support strategy designed to improve outcome for patients with out-of-hospital refractory ventricular fibrillation/ventricular tachycardia (VF/VT). We report the outcomes of the initial 3-month period of operations. Methods and Results--Three emergency medical services systems serving the Minneapolis-St. Paul metro area participated in the protocol. Inclusion criteria included age 18 to 75 years, body habitus accommodating automated Lund University Cardiac Arrest System (LUCAS) cardiopulmonary resuscitation (CPR), and estimated transfer time from the scene to the cardiac catheterization laboratory of ≤30 minutes. Exclusion criteria included known terminal illness, Do Not Resuscitate/Do Not Intubate status, traumatic arrest, and significant bleeding. Refractory VF/VT arrest was defined as failure to achieve sustained return of spontaneous circulation after treatment with 3 direct current shocks and administration of 300 mg of intravenous/intraosseous amiodarone. Patients were transported to the University of Minnesota, where emergent advanced perfusion strategies (extracorporeal membrane oxygenation; ECMO), followed by coronary angiography and primary coronary intervention (PCI), were performed, when appropriate. Over the first 3 months of the protocol, 27 patients were transported with ongoing mechanical CPR. Of these, 18 patients met the inclusion and exclusion criteria. ECMO was placed in 83%. Seventy-eight percent of patients had significant coronary artery disease with a high degree of complexity and 67% received PCI. Seventy-eight percent of patients survived to hospital admission and 55% (10 of 18) survived to hospital discharge, with 50% (9 of 18) achieving good neurological function (cerebral performance categories 1 and 2). No significant ECMO-related complications were encountered. Conclusions--The MRC refractory VF/VT protocol is feasible and led to a high functionally favorable survival rate with few complications.

Original languageEnglish (US)
Article numbere003732
JournalJournal of the American Heart Association
Volume5
Issue number6
DOIs
StatePublished - Jun 1 2016

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Ventricular Fibrillation
Resuscitation
Reperfusion
Perfusion
Ventricular Tachycardia
Cardiopulmonary Resuscitation
Extracorporeal Membrane Oxygenation
Amiodarone
Emergency Medical Services
Cardiac Catheterization
Heart Arrest
Coronary Angiography
Coronary Artery Disease
Shock
Survival Rate
Hemorrhage

Keywords

  • Emergent extracorporeal membrane oxygenation
  • Extra-corporeal membrane oxygenation
  • Perfusion
  • Refractory ventricular fibrillation/ventricular tachycardia
  • Resuscitation
  • Ventricular fibrillation

Cite this

Minnesota Resuscitation Consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation. / Yannopoulos, Demetri; Bartos, Jason A; Martin, Cindy M; Raveendran, Ganesh; Missov, Emil; Conterato, Marc; Frascone, Ralph; Trembley, Alexander; Sipprell, Kevin; John, Ranjit; George, Stephen A; Carlson, Kathleen P; Brunsvold, Melissa E; Garcia, Santiago; Aufderheide, Tom P.

In: Journal of the American Heart Association, Vol. 5, No. 6, e003732, 01.06.2016.

Research output: Contribution to journalArticle

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abstract = "Background--In 2015, the Minnesota Resuscitation Consortium (MRC) implemented an advanced perfusion and reperfusion life support strategy designed to improve outcome for patients with out-of-hospital refractory ventricular fibrillation/ventricular tachycardia (VF/VT). We report the outcomes of the initial 3-month period of operations. Methods and Results--Three emergency medical services systems serving the Minneapolis-St. Paul metro area participated in the protocol. Inclusion criteria included age 18 to 75 years, body habitus accommodating automated Lund University Cardiac Arrest System (LUCAS) cardiopulmonary resuscitation (CPR), and estimated transfer time from the scene to the cardiac catheterization laboratory of ≤30 minutes. Exclusion criteria included known terminal illness, Do Not Resuscitate/Do Not Intubate status, traumatic arrest, and significant bleeding. Refractory VF/VT arrest was defined as failure to achieve sustained return of spontaneous circulation after treatment with 3 direct current shocks and administration of 300 mg of intravenous/intraosseous amiodarone. Patients were transported to the University of Minnesota, where emergent advanced perfusion strategies (extracorporeal membrane oxygenation; ECMO), followed by coronary angiography and primary coronary intervention (PCI), were performed, when appropriate. Over the first 3 months of the protocol, 27 patients were transported with ongoing mechanical CPR. Of these, 18 patients met the inclusion and exclusion criteria. ECMO was placed in 83{\%}. Seventy-eight percent of patients had significant coronary artery disease with a high degree of complexity and 67{\%} received PCI. Seventy-eight percent of patients survived to hospital admission and 55{\%} (10 of 18) survived to hospital discharge, with 50{\%} (9 of 18) achieving good neurological function (cerebral performance categories 1 and 2). No significant ECMO-related complications were encountered. Conclusions--The MRC refractory VF/VT protocol is feasible and led to a high functionally favorable survival rate with few complications.",
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T1 - Minnesota Resuscitation Consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation

AU - Yannopoulos, Demetri

AU - Bartos, Jason A

AU - Martin, Cindy M

AU - Raveendran, Ganesh

AU - Missov, Emil

AU - Conterato, Marc

AU - Frascone, Ralph

AU - Trembley, Alexander

AU - Sipprell, Kevin

AU - John, Ranjit

AU - George, Stephen A

AU - Carlson, Kathleen P

AU - Brunsvold, Melissa E

AU - Garcia, Santiago

AU - Aufderheide, Tom P.

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N2 - Background--In 2015, the Minnesota Resuscitation Consortium (MRC) implemented an advanced perfusion and reperfusion life support strategy designed to improve outcome for patients with out-of-hospital refractory ventricular fibrillation/ventricular tachycardia (VF/VT). We report the outcomes of the initial 3-month period of operations. Methods and Results--Three emergency medical services systems serving the Minneapolis-St. Paul metro area participated in the protocol. Inclusion criteria included age 18 to 75 years, body habitus accommodating automated Lund University Cardiac Arrest System (LUCAS) cardiopulmonary resuscitation (CPR), and estimated transfer time from the scene to the cardiac catheterization laboratory of ≤30 minutes. Exclusion criteria included known terminal illness, Do Not Resuscitate/Do Not Intubate status, traumatic arrest, and significant bleeding. Refractory VF/VT arrest was defined as failure to achieve sustained return of spontaneous circulation after treatment with 3 direct current shocks and administration of 300 mg of intravenous/intraosseous amiodarone. Patients were transported to the University of Minnesota, where emergent advanced perfusion strategies (extracorporeal membrane oxygenation; ECMO), followed by coronary angiography and primary coronary intervention (PCI), were performed, when appropriate. Over the first 3 months of the protocol, 27 patients were transported with ongoing mechanical CPR. Of these, 18 patients met the inclusion and exclusion criteria. ECMO was placed in 83%. Seventy-eight percent of patients had significant coronary artery disease with a high degree of complexity and 67% received PCI. Seventy-eight percent of patients survived to hospital admission and 55% (10 of 18) survived to hospital discharge, with 50% (9 of 18) achieving good neurological function (cerebral performance categories 1 and 2). No significant ECMO-related complications were encountered. Conclusions--The MRC refractory VF/VT protocol is feasible and led to a high functionally favorable survival rate with few complications.

AB - Background--In 2015, the Minnesota Resuscitation Consortium (MRC) implemented an advanced perfusion and reperfusion life support strategy designed to improve outcome for patients with out-of-hospital refractory ventricular fibrillation/ventricular tachycardia (VF/VT). We report the outcomes of the initial 3-month period of operations. Methods and Results--Three emergency medical services systems serving the Minneapolis-St. Paul metro area participated in the protocol. Inclusion criteria included age 18 to 75 years, body habitus accommodating automated Lund University Cardiac Arrest System (LUCAS) cardiopulmonary resuscitation (CPR), and estimated transfer time from the scene to the cardiac catheterization laboratory of ≤30 minutes. Exclusion criteria included known terminal illness, Do Not Resuscitate/Do Not Intubate status, traumatic arrest, and significant bleeding. Refractory VF/VT arrest was defined as failure to achieve sustained return of spontaneous circulation after treatment with 3 direct current shocks and administration of 300 mg of intravenous/intraosseous amiodarone. Patients were transported to the University of Minnesota, where emergent advanced perfusion strategies (extracorporeal membrane oxygenation; ECMO), followed by coronary angiography and primary coronary intervention (PCI), were performed, when appropriate. Over the first 3 months of the protocol, 27 patients were transported with ongoing mechanical CPR. Of these, 18 patients met the inclusion and exclusion criteria. ECMO was placed in 83%. Seventy-eight percent of patients had significant coronary artery disease with a high degree of complexity and 67% received PCI. Seventy-eight percent of patients survived to hospital admission and 55% (10 of 18) survived to hospital discharge, with 50% (9 of 18) achieving good neurological function (cerebral performance categories 1 and 2). No significant ECMO-related complications were encountered. Conclusions--The MRC refractory VF/VT protocol is feasible and led to a high functionally favorable survival rate with few complications.

KW - Emergent extracorporeal membrane oxygenation

KW - Extra-corporeal membrane oxygenation

KW - Perfusion

KW - Refractory ventricular fibrillation/ventricular tachycardia

KW - Resuscitation

KW - Ventricular fibrillation

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