The center for the treatment of sudden cardiac death: the results of five years of work

Abstract

The objective was to summarize the Center's experience in the treatment of sudden cardiac death and to assess the prospects of using venoarterial extracorporeal membrane oxygenation (VA ECMO) in the complex of extended cardiopulmonary resuscitation (CPR).Materials and methods.  109 patients aged 52.6±1.5 years, delivered  to the hospital  by emergency  medical teams with a background of ongoing cardiopulmonary resuscitation.Results. In the majority of cases (78), extended resuscitation measures were ineffective, ECMO was not used due to inadequate technology connection criteria. In 15 cases, primary stabilization without ECMO was achieved, and these patients were transferred for further treatment to intensive care unit (ICU), 8 of them died later. Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 16 cases, in 6 cases, patients were decannulated after cardiac recovery; also, ECMO was used postmortem 15 times to preserve donor organs. The overall survival rate among the delivered to the Center was 7.5%. We found out the correlation between the duration of the prehospital period and survival rate (time to hospital admission in survivors was 42.7±9.6 min versus 64.31±3.13 min in the deceased). The association between pH (AUC ROC 0.728) on admission and favorable outcome was found to be more reliable than EtCO2 (0.266) and blood lactate  (0.387).Conclusion. The creation of centers for the treatment of patients with refractory circulatory arrest seems reasonable on the basis of level 3 hospitals with the possibility  of using X-ray surgical methods  of treatment. The widespread  introduction of ECPR should be accompanied  by the change of CPR  algorithms  in the prehospital period. The effectiveness of ECPR is determined by mandatory strict  adherence  to the connection criteria, which can be revised as experience accumulates.