|
Author |
Jennie Helmer |
Date |
2019-10-02 |
|
Reviewer |
- |
Edited |
2020-10-22 |
You respond to a patient who was ice-fishing and unfortunately, fell into the fishing hole. The patient was able to hang on to the edge and did not go under water. During rescue, he reportedly went unresponsive and pulseless. Approximately 20 minutes passed before the patient was successfully recovered. Once extricated, the patient was unresponsive and pulseless. The rescuers begin compressions, and the patient is brought to you with resuscitation ongoing.
You and your team continue with resuscitation, and you contact CliniCall to discuss the possibility of ECMO (Extracorporeal Membrane Oxygenation) for this suspected hypothermic arrest. The Paramedic Specialist conferences EPOS onto the call and they discuss the case with you. The recommendation is that you transport this patient to an ECMO-capable hospital 45 minutes away.
Why did the EPOS/PS recommend you transport this suspected hypothermic-arrest patient to an ECMO facility, rather than staying on scene and managing your patient with standard cardiac arrest management?
“In pre-hospital patients experiencing cardiac arrest due to hypothermia, does ECMO versus standard CA management improve neurological survival?”
|
Population |
Adult patient with hypothermic cardiac arrest |
|
Intervention |
ECMO (Extracorporeal Membrane Oxygenation) |
|
Comparison |
Standard AHA cardiac arrest management |
|
Outcome |
Improvement in Neurological Survival |
Pubmed: (“Prehospital Patients in Hypothermic Cardiac Arrest” OR “Accidental Hypothermia” OR “out-of-hospital Patients in Hypothermic Cardiac Arrest”) AND (“ECMO” OR “Extracorporeal Membrane Oxygenation” OR “ECLS” OR “Extracorporeal Membrane Oxygenation”) AND ( “CPR” OR “Standard Cardiac Arrest Management” OR “Cardiopulmonary Resuscitation”) AND ( “Survival” OR “ROSC” OR “Return of Spontaneous Circulation” OR “Neurologically Intact Survival”)
29 Results (7 Relevant) on 2019-10-02
These papers provide supportive evidence for the use of ECMO and is the rewarming strategy of choice for hypothermic cardiac arrest patients, and should be considered if feasible in under 6 hours. One study (Paal, 2016) reported that ECMO has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.
Paramedics should contact CliniCall with any suspected Hypothermic Cardiac Arrest, and familiarize themselves with the BCEHS Handbook and Cardiac Arrest-Treatable Cause section.