🔸ECPR improves survival with good neuro outcome🔸

We just published the first meta-analysis of 4 RCTs

➡️ More OHCA patients had good neuro outcome when randomized to #ECPR (27% vs 18%, p=0.02)

🧵 Learn more in the thread /11

🔗 onlinelibrary.wiley.com/doi/full/10.11…

#FOAMcc #ResusTwitter
2/

In refractory OHCA, VA-#ECMO during ongoing CPR, known as #ECPR, can restore and maintain organ perfusion limiting brain injury

Growing evidence suggest that this approach can improve survival and neuro outcome

#FOAMcc #ResusTwitter
3/

After decades of evidence from non-RCTs, 3 single-center RCTs investigated #ECPR vs conventional CPR and 2 suggested a potential benefit

In 2023, the first multi-center RCT (INCEPTION) was published and showed no major differences in outcomes

#FOAMcc #ResusTwitter
4/

INCEPTION trial results contrasted with previous studies and expert opinions generating intense debate around #ECPR

Therefore, to ascertain the effect of ECPR vs conventional CPR we conducted a meta-analysis focusing on RCTs only (4 studies, 433 pts)

5/

In our meta-analysis of RCTs, survival with favorable neuro outcome at the longest follow-up was higher with #ECPR vs conventional CPR (27% vs 18% p=0.02)

The highest benefit was observed in patients with an initial shockable rhythm (34% vs 23% p=0.01)

#FOAMcc #ResusTwitter
6/

In terms of number needed to treat (#NNT), to achieve 1 additional survivor with good neuro outcome we should treat with #ECPR

- 9 (95% CI, 5-66) pts with all-rhythm refractory OHCA
- 7 (95% CI, 4-31) with an initial VF

and favorable characteristics.

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7/

While we demonstrated that #ECPR improved survival with good neuro outcome, no differences in overall survival at hospital discharge or 30 days and at 3 or 6 months were found when pooling these 4 RCTs

#FOAMcc #ResusTwitter
8/

All RCTs, except EROCA pilot trial, reported a consistent direction of effect in favour of #ECPR, with ARREST and Prague OHCA study reporting a statistically significant difference up to 180 days and at 30 days only, respectively

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9/

#ECPR is highly debated due to the important resources needed despite it’s a lifesaving intervention now supported by high-quality RCTs

However, it should be noted that beneficial effects in this meta-analysis is driven by 2 RCTs in single, high-performing centers.

#FOAMcc
10/

Implementing #ECPR in different settings/systems might fail to reproduce beneficial effects observed in this meta-analysis of single-center RCTs

ECPR is complex and requires a well-organized system, experience and a high-volume ECMO-capable cardiac arrest centers

#FOAMcc
11/

Future research should aim to identify the most effective strategy to provide #ECPR based on system-level characteristics, address logistical barriers of extracorporeal CPR, and improve patient selection

#FOAMcc #ResusTwitter
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More from @tscquizzato

Jan 22
4 RCTs published in the last few hours you can’t miss if you work with critically ill patients:

#1 Fluids in septic shock
#2 Mobilisation and long-term cognitive impairment
#3 NIV for extubation of obese patients
#4 Nutrition before extubation

A thread 🧵👇

#FOAMcc #SCCM2023
#1

#CLOVERStrial compared a restrictive fluid strategy (with early vasopressors) to a liberal one in septic shock patients.

➡️ Restrictive fluid strategy (with early vasopressors) did not result in significantly lower (or higher) mortality

🔗 nej.md/3CWSXBA

#FOAMcc
#2

What’s the effect of early mobilisation on long-term cognitive impairment in ICU survivors after mechanical ventilation?

➡️ Early mobilisation improved long-term cognitive impairment at 1 y (24% vs 43%) but increased adverse events (6%)

🔗 bit.ly/3CYIZQ7

#FOAMcc
Read 6 tweets
Jan 21
ECPR for OHCA: Pre-hospital or in-hospital?

Happy to share this Editorial written with @Alice_hutin and @giovannilandoni commenting on a SR/MA by @nattiejpk investigating the role of pre-hospital #ECPR.

🧵👇 Learn more in the thread /17

🔗 bit.ly/3ZQQNNG #ResusTwitter
2/

#ECPR is the last rescue therapy when despite high-quality conventional CPR it is not possible to achieve ROSC.

In such situations, OHCA is considered refractory and E-CPR recently demonstrated to improve outcomes in selected patients.

#ResusTwitter
3/

@nattiejpk recently conducted a SRMA published on @JCVAonline investigating effect of preh initiation of #ECPR on low-flow and survival

Most evidence comes from Paris, first EMS applying preh ECPR since 2011 @LionelLamhaut @alice_hutin

#ResusTwitter
Read 18 tweets
Jun 16, 2021
THREAD and my infographic of the #TTM2 trial

#OHCA patients were randomised to #TTM at 33°C or normothermia (<37.8°C) with early fever treatment.

➡️ Mortality and poor neuro outcome at 6 months were not lower in the hypothermia group.

🔗 nejm.org/doi/full/10.10… #FOAMcc Image
Guidelines recommend selecting and maintaining a constant target #TTM between 32 and 36 °C in comatose post-cardiac arrest patients to prevent hypoxic-ischemic brain damage.
(strong recommendation, moderate-quality evidence). #FOAMcc Image
Two RCTs published in 2002 showed an improved survival and neurologic outcome in patients resuscitated from OHCA of presumed cardiac cause and shockable rhythm who underwent hypothermia at 33°C. #FOAMcc Image
Read 6 tweets
Jun 11, 2020
*Thread on #FirstResponders for OHCA*

In the last decade, numerous systems like @pulsepoint @GoodSamApp @SAUVLife @HartslagNu were developed to alert laypersons.

In this review, we provide an overview of published technologies and analyze their impact on pts outcomes.

#FOAMed Image
How does a citizens first responder system work?

Citizens willing to help in case of OHCA can voluntarily register in a first responder network.

When an OHCA occurs, the nearest ones are alerted simultaneously with #EMS dispatch to increase CPR rates before ambulance arrival. ImageImage
Our systematic review found 12 different systems (7 apps, 5 text message systems).

Activation radius varied from 150 m to 5 km. Also activation criteria, training required, technology used, and active time varied between systems and are summarized below 👇 Image
Read 12 tweets

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