Media Report

Issues in Establishing The Refractory Out-Of-Hospital Cardiac Arrest Treated With
Mechanical CPR, Hypothermia, ECMO And Early Reperfusion
(CHEER) study
D Stub 1,2,3 , S Bernard 1,2,4 , V Pellegrino 1 , K Smith 2,4 , Tony Walker 4 , M Stephenson 4 , J
Shendylake 1 , L Hockings 1 , S Duffy 1,2,3 , J Shaw 1,2,3 , P Cameron 1,2 , D Smit 1 , D Kaye 1,2,3
1 Alfred Hospital, 2 Monash University, 3 Baker IDI Heart and Diabetes Research Institute,
4 Ambulance Victoria
Background: Survival after out-of-hospital cardiac arrest (OHCA) remains poor. There is
growing international interest in utilizing extracorporeal membrane oxygenation assisted
CPR (ECPR) to improve management of cardiac arrest. We seek to describe our
experiences in establishing Australia’s first pilot trial into ECPR and refractory VF OHCA.
Methods: The Refractory Out-Of-Hospital Cardiac Arrest Treated With Mechanical CPR,
Hypothermia, ECMO And Early Reperfusion (CHEER study) is collaboration between the
Alfred Hospital and Ambulance Victoria. In the pre-hospital phase patients with refractory VF
arrest within study recruitment hours are placed on the Zoll Auto Pulse, administered 2L of
ice-cold saline and transported code-1 to the Alfred Hospital together with standard
resuscitation measures. The ECPR team is mobilised to the emergency department,
whereby, the femoral artery and vein are percutaneously cannulated for VA-ECMO, and the
patient cooled to 33 0 . A coronary angiogram+/-intervention is then performed followed by 24
hours of cooling, ventilation and hemodynamic support.
Results: Three MICA units have been trained on the trial protocol and use of the Autopulse
since September 2011. Issues of percutaneous insertion of ECMO during active CPR have
been significantly assisted by real time vascular ultrasound. Five patients have experienced
refractory OHCA (VF>60minutes). In 4 patients return of spontaneous circulation was
achieved, with 3 patients (60%) making a complete neurological recovery with hospital
discharge on Day 7, 8 and 9 respectively.
Conclusions: Establishing an ECPR program with cooperation from local ambulance crews
is feasible. Further research into the efficacy and resource implications of ECPR is needed.