A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study
Abstract Background The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygen...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-024-01198-x |
| _version_ | 1827276999690813440 |
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| author | Samir Ali Xavier Moors Hans van Schuppen Lars Mommers Ellen Weelink Christiaan L. Meuwese Merijn Kant Judith van den Brule Carlos Elzo Kraemer Alexander P. J. Vlaar Sakir Akin Annemiek Oude Lansink-Hartgring Erik Scholten Luuk Otterspoor Jesse de Metz Thijs Delnoij Esther M. M. van Lieshout Robert-Jan Houmes Dennis den Hartog Diederik Gommers Dinis Dos Reis Miranda |
| author_facet | Samir Ali Xavier Moors Hans van Schuppen Lars Mommers Ellen Weelink Christiaan L. Meuwese Merijn Kant Judith van den Brule Carlos Elzo Kraemer Alexander P. J. Vlaar Sakir Akin Annemiek Oude Lansink-Hartgring Erik Scholten Luuk Otterspoor Jesse de Metz Thijs Delnoij Esther M. M. van Lieshout Robert-Jan Houmes Dennis den Hartog Diederik Gommers Dinis Dos Reis Miranda |
| author_sort | Samir Ali |
| collection | DOAJ |
| description | Abstract Background The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. Methods The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. Discussion The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. Trial registration Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020. |
| first_indexed | 2024-04-24T07:12:22Z |
| format | Article |
| id | doaj.art-ea6d64d71b5f4371be1f8834f7cc51e0 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-04-24T07:12:22Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-ea6d64d71b5f4371be1f8834f7cc51e02024-04-21T11:28:19ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412024-04-0132111010.1186/s13049-024-01198-xA national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE studySamir Ali0Xavier Moors1Hans van Schuppen2Lars Mommers3Ellen Weelink4Christiaan L. Meuwese5Merijn Kant6Judith van den Brule7Carlos Elzo Kraemer8Alexander P. J. Vlaar9Sakir Akin10Annemiek Oude Lansink-Hartgring11Erik Scholten12Luuk Otterspoor13Jesse de Metz14Thijs Delnoij15Esther M. M. van Lieshout16Robert-Jan Houmes17Dennis den Hartog18Diederik Gommers19Dinis Dos Reis Miranda20Department of Intensive Care, Erasmus University Medical CentreDepartment of Anaesthesiology, Erasmus Medical CentreHelicopter Emergency Medical Services, Netwerk Acute Zorg Noordwest, Amsterdam University Medical CentreHelicopter Emergency Medical Service, Radboud University Medical CentreHelicopter Emergency Medical Service, University Medical Centre GroningenDepartment of Intensive Care, Erasmus University Medical CentreDepartment of Intensive Care, Amphia HospitalDepartment of Intensive Care Medicine, Radboud University Medical CentreDepartment of Intensive Care Medicine, Leiden University Medical CentreDepartment of Intensive Care Medicine, Amsterdam University Medical CentreDepartment of Intensive Care, Haga Teaching HospitalDepartment of Critical Care, University Medical Centre GroningenDepartment of Intensive Care, St. Antonius HospitalDepartment of Intensive Care, Catharina HospitalDepartment of Intensive Care, OLVGDepartment of Intensive Care, Maastricht University Medical CentreTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre RotterdamHelicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical CentreTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre RotterdamDepartment of Intensive Care, Erasmus University Medical CentreDepartment of Intensive Care, Erasmus University Medical CentreAbstract Background The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. Methods The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. Discussion The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. Trial registration Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.https://doi.org/10.1186/s13049-024-01198-xOut-of-hospital cardiac arrestExtracorporeal membrane oxygenationCardiopulmonary resuscitationAdvanced cardiac life support |
| spellingShingle | Samir Ali Xavier Moors Hans van Schuppen Lars Mommers Ellen Weelink Christiaan L. Meuwese Merijn Kant Judith van den Brule Carlos Elzo Kraemer Alexander P. J. Vlaar Sakir Akin Annemiek Oude Lansink-Hartgring Erik Scholten Luuk Otterspoor Jesse de Metz Thijs Delnoij Esther M. M. van Lieshout Robert-Jan Houmes Dennis den Hartog Diederik Gommers Dinis Dos Reis Miranda A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Out-of-hospital cardiac arrest Extracorporeal membrane oxygenation Cardiopulmonary resuscitation Advanced cardiac life support |
| title | A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study |
| title_full | A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study |
| title_fullStr | A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study |
| title_full_unstemmed | A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study |
| title_short | A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study |
| title_sort | national multi centre pre hospital ecpr stepped wedge study design and rationale of the on scene study |
| topic | Out-of-hospital cardiac arrest Extracorporeal membrane oxygenation Cardiopulmonary resuscitation Advanced cardiac life support |
| url | https://doi.org/10.1186/s13049-024-01198-x |
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