From ECPR to ECMO. Steve Bernard examines evolving trends and technology for post-arrest care in Australia. Hear the talk on Intensive Care Network.

1. Age 0.957 0.950 - 0.964 0.001
EMS arrival to ROSC
time
0.998 0.896 - 0.920 0.001
EMS Response time 0.968 0.940 - 0.997 0.03
No EMS Intubation
Patient GCS 8
4.96* 2.60 – 9.59 0.001
No EMS intubation
Patient GCS 8
1.64* 1.10 – 2.43 0.015
Initial rhythm VF/VT 4.31 3.41 – 5.45 0.001
Witnessed arrest 1.50 1.16 – 1.93 0.002
Bystander CPR 1.31 1.06 – 1.61 0.011
Transport to Cardiac
Centre
1.40 1.12 – 1.74 0.003
Admission in hours
(0800-1700)
1.34 1.10 – 1.64 0.004
Male Gender 1.30 1.03 – 1.64 0.025

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Victorian Ambulance Cardiac Arrest Register
(VACAR)
3620 OHCA cases
Median age was 69 years, 70% were male, and
60% were in a shockable rhythm on ambulance
arrival
For VF/VT patients, survival was maximal at 120-
129mmHg (54%)
Bray J, Bernard S, Cantwell K, et al. Resuscitation 2014; Apr;85(4):509-15

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32. To the ICU:
Cooling for 24 hours
33C
Slow rewarming over
24 hours @ 0.25C/hr
ECMO out when ROSC
or CNS hopeless

33. THE CHEER TRIAL
February 2012 to January 2014
21 patients had attempted E-CPR
9/21 with out-of-hospital cardiac arrest
The site of cannulation
o 13/21 (62%) in the ED
o 7/21 (33%) in the ICU
o 1/21 (5%) in the cath lab
The average age 47 years (21-62)
16/21 (76%) male

34. THE CHEER TRIAL
Percutaneous cannulation was
successful in 19/21 (90.5%)
The average duration of ECMO support
in the 19 cannulated patients was 4.2
days
13/21 (62%) patients awoke and 12/21
(57%) patients were discharged home

38. I have a dream….
Post arrest patient go to a 24/7 cath lab
hospital with interested staff
Post arrest team?
ECPR available in selected centres (at
least one in each capital city)
ED or ICU driven
IAOC for arrest due to bleeding
subdiaphragm