Jason Bartos and his crew at the University
of Minnesota have revolutionized the concept of ECPR for out of hospital cardiac arrests. His crew are interventional cardiologists who take OHCA straight to the cardiac cath lab. They have initiate times of around 6-8 minutes and have neurologically intact survival rates higher than 30%. Below are two of Jason’s recent papers which every person who considers themselves an ECPR fan should pour over with a fine-toothed comb. There is so much in these papers. We split this interview into two pieces because there is so many pearls in it.
Resuscitation paper – 48% survival in 100 patients
Circulation paper 2020– 33% vs. 23% ALPS
- Cohort who had VF/VT and one shock vs. a cohort who had VF/VT and failed to ROSC at the scene, in the ambulance, and then all the way to the hospital.
- OHCA – > Straight to the Cath lab –> Get on ECMO –> Go to CCU under Cards care.
- Inclusion criteria – Vf/vt, lactate <18, paO2 >50,ETCO2>10
Bartos JA, Grunau B, Carlson C, Duval S, Ripeckyj A, Kalra R, Raveendran G, John R, Conterato M, Frascone RJ, Trembley A, Aufderheide TP, Yannopoulos D. Improved Survival with Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated with Prolonged Resuscitation. Circulation. 2020 Jan 3. doi: 10.1161/CIRCULATIONAHA.119.042173. [Epub ahead of print] PubMed PMID: 31896278.
Bartos JA, Carlson K, Carlson C, Raveendran G, John R, Aufderheide TP, Yannopoulos D. Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: Critical care and extracorporeal membrane oxygenation management. Resuscitation. 2018 Nov;132:47-55. doi: 10.1016/j.resuscitation.2018.08.030. Epub 2018 Aug 29. PubMed PMID: 30171974.