Thread by @teddyhla

Dr Nicholas Barrett, president of @EuroELSO discussing Research in this area, especially clinical data registries @iceman_ex @MLSCourse @tamishtah #UKECPR23

But what #kind of #registries ? - Patient, Specialty, Device ? e.g., Abiomed Imeplla registry data. Regulatory process is different - FDA normally requires RCT. Abiomed registry data was compelling , resulting in +++ impella uptake in USA. #UKECPR23

But wait --- Imeplla in high volume centre - actually your outcomes are worse. Amin (2020) "Impella use was associated with higher rates of adverse events and costs" #UKECPR23
pubmed.ncbi.nlm.nih.gov/31735078/

Dr Barrett : Registry data needs to be taken with a large chunk of #SALT #UKECPR23

And of course @EuroELSO own registry elso.org/registry.aspx There are large volume registries emerging in China. #UKECPR23
Ok-- what about ECPR ?

ECPR demand is rising yet incidence is still low

pubmed.ncbi.nlm.nih.gov/27993632/ ECPR survival

Let’s talk about reduced incidence. Here is U.K. data #ukecpr23 - extraordinary

So essentially 7 patients out of screening for 1,000 patients! wow 😲 Here is the paper #UKECPR23 pubmed.ncbi.nlm.nih.gov/36561209/

But Cooling -- cooling may be benficiable in early duration.
French registry data - where SAMU has very well established service. What is their data. from 24 000 OOHCA, prehospital ECMO 136, 389 in hospital ECMO. #UKECPR23

pubmed.ncbi.nlm.nih.gov/31670793/ Here is the paper. #UKECPR23

SAVE J-II ccforum.biomedcentral.com/articles/10.11… A lot of subgroup analysis- #shockable rhythm again comes up. #30-45 mins seems sweet spot #UKECPR23

Dr Nicholas Barrett . data from registry - very similar to RCT data
incidence remains low
shockable rhythm and quick ECPR remains key variables. Registry are 'data rich'. allow Machine Learning tools or other analysis to provide deeper insights. #UKECPR23

But his takehome message : We dont do enough basic science research. especially in refractory OOHCA -- we dont really understand mechanistically what is happening. We do need #registries We do need #control group in research. but we also need ++++basic science research #UKECPR23

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