HYPERINVASIVE APPROACH PROLONGS TIME FOR FAVORABLE SHORTTERM OUTCOME IN REFRACTORY OHCA. PILOT RESULTS OF THE “PRAGUE OHCA STUDY"

Purpose: Recent studies of ECLS (extracorporeal life support) in out of hospital cardiac arrest (OHCA) suggest randomized studies. Ongoing randomized study compares hyperinvasive (H) approach (intraarrest hypothermia combined with mechanical compressions, intrahospital ECLS and early invasive investigation) to a standard (S) care in patients with refractory OHCA of cardiac origin.

Methods: Patients with witnessed OHCA without return of spontaneous circulation after a minimum of 5 minutes of ACLS were randomized during ongoing CPR (cardiopulmonary resuscitation) to H vs. S arm. Patients were evaluated as treated, 30-day survival, neurological and cardiac recovery in relation to CPR time was determined. CPR time was defined as a time to ROSC or to death or to running ECLS.
Results: Since Mar 2013 to Sep 2015, 51 patients were randomized, 24 to S, 27 to H arm, in 7 patients, cross-over from S to H arm occured. Patients were 55±12 years old, 41 (80%) male and acute coronary syndrome was a cause of OHCA in 35 (69%) cases. In S arm, 4 (24%) patients survived 30 days and reached both cardiac and neurological recovery. In H+Cross arms, 13 (38%) patients survived, 13 (38%) reached cardiac and 10 (29%) neurological recovery, p = NS for all comparisons to S arm, respectively. However, patients in S arm had significantly shorter overall CPR time, 40 (31.25-59.5) vs. 60,5 (53.0-71.0) min, p = 0.018, see figure 1.
Conclusion: Hyperinvasive approach prolongs time for a favorable outcome in long cardiac arrests of cardiac origin and is a viable option in refractory OHCA.
Acknowledgement: the study has been approved by an Institutional Review Board, is supported by a research grant from Ministry of Health, Czech Republic NT 13225-4/2012 and is registered under ClinicalTrials.gov: NCT01511666.