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

Abstract

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. 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. 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. 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.