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DOI: 10.1055/a-2384-9363
Welchen Einfluss hat die Entfernung zwischen dem Notfallort und dem ECLS-Zentrum auf die Low-Flow-Zeit von ECPR-Patienten?
What Influence Does the Distance Between the Emergency Site and the ECLS Center Have on the Low-flow Time of ECPR Patients?
Zusammenfassung
Hintergrund
Die extrakorporale kardiopulmonale Reanimation (ECPR) als Bridging-Verfahren bei refraktärem Kreislaufstillstand ist eine herausfordernde Strategie. Umfassende evidenzbasierte Einschlusskriterien im Hinblick auf das neurologische Outcome liegen nicht vor, die Dauer der konventionellen Reanimation ist wahrscheinlich ein Faktor. Gegenstand dieser Untersuchung ist, ob die Entfernung des Notfallortes vom ECPR-Zentrum eine entscheidende Bedeutung für die Zeit bis zum ECPR-Start ist.
Methodik
Retrospektive Datenanalyse von 143 Patienten, die einen Kreislaufstillstand erlitten haben und in ein ECLS-Zentrum transportiert wurden.
Ergebnisse
Die Dauer der CPR bis Aufnahme lag bei 63 min (50–80 min), die Gesamtdauer der CPR bei Start ECPR (Gesamt-Low-Flow-Zeit) lag bei 100 min (80–115 min) – beide Zeitangaben korrelierten nicht signifikant mit der Entfernung vom Notfallort zum ECPR-Zentrum.
Diskussion
Wir fanden keine signifikante Korrelation zwischen der Entfernung des Notfallortes zum ECLS-Zentrum und der Dauer vom Beginn der CPR bis zum Eintreffen im Zentrum. Möglicherweise sind also andere logistische Faktoren entscheidend für die Dauer bis zum Eintreffen im Zentrum. Die vorliegenden Daten erlauben diesbezüglich keine weiteren Rückschlüsse. Damit scheint aber die These untermauert, dass eine Erhöhung der Anzahl der ECLS-Zentren mit konsekutiver Verkürzung der Anfahrtsstrecke keine geeignete Maßnahme ist, um die Dauer der mechanischen Reanimation und damit die Low-Flow-Zeit zu minimieren. Der präklinische ECMO-Einsatz könnte einen Lösungsansatz bieten.
Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) as a bridging procedure for refractory circulatory arrest is a challenging strategy. Comprehensive evidence-based inclusion criteria with regard to neurological outcome are not available, and the duration of conventional resuscitation is probably a factor. The aim of this study is to determine whether the distance of the emergency scene from the ECPR centre is a determining factor in the time to ECPR initiation.
Methods
Retrospective data analysis of 143 patients who suffered a cardiac arrest and were transported to an ECLS centre.
Results
The duration of CPR to admission was 63 min (50-80 min), the total duration of CPR at the start of ECPR (total low-flow time) was 100 min (80-115 min) - both times did not correlate significantly with the distance from the emergency scene to the ECPR centre.
Discussion
We found no significant correlation between the distance from the emergency scene to the ECLS centre and the time from the start of CPR to arrival at the centre. It is therefore possible that other logistical factors are decisive for the duration until arrival at the centre. The available data do not allow any further conclusions to be drawn in this regard. However, this seems to support the thesis that an increase in the number of ECLS centres with a consecutive shortening of the journey to the centre is not a suitable measure to minimise the duration of mechanical resuscitation and thus the low-flow time. The pre-hospital use of ECMO could offer a solution.
Schlüsselwörter
refraktärer Kreislaufstillstand - Extracorporeal Life Support - Distanz - Low Flow - ECPRPublikationsverlauf
Eingereicht: 13. Februar 2024
Angenommen nach Revision: 15. Juni 2024
Artikel online veröffentlicht:
02. September 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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