• Giovanni Mistraletti, Armando Lancioni, Gabriele Bassi, Francesca Nespoli, Michele Umbrello, Silvia Salini, Alberto Zangrillo, Federico Pappalardo, Anna Mara Scandroglio, Giuseppe Foti, Leonello Avalli, Nicolò Patroniti, Ferdinando Raimondi, Elena Costantini, Emanuele Catena, Davide Ottolina, Claudia Ruffini, Maurizio Migliari, Giovanni Sesana, Roberto Fumagalli, Antonio Pesenti, and mechCPR-ECLS investigators.
• Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; UOC Anestesia e Rianimazione, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Milano, Italy. Electronic address: giovanni.mistraletti@unimi.it.
• Resuscitation. 2023 Jan 1; 182: 109659109659.

BackgroundReturn of spontaneous circulation (ROSC) is achieved in 25% of out-of-hospital cardiac arrest (OHCA) patients. Mechanical chest compression (mechCPR) may maintain better perfusion during transport, allowing hospital treatments like extracorporeal circulation life support (ECLS). We aim to assess the effectiveness of a pre-hospital protocol introduction.MethodsObservational, retrospective study assessing all OHCA patients aged 12-75, with no-flow time <20 min in a metropolitan area (Milan, Italy, 2013-2016).Primary OutcomesROSC and Cerebral Performance Category score (CPC) ≤2 at hospital discharge. Logistic regressions with multiple comparison adjustments balanced with propensity scores calculated with inverse probability of treatment weighting were performed.Results1366 OHCA were analysed; 305 received mechCPR, 1061 manual chest compressions (manCPR), and 108 ECLS. ROSC and CPC ≤2 were associated with low-flow minutes (odds ratio [95% confidence interval] 0.90 [0.88-0.91] and 0.90 [0.87-0.93]), shockable rhythm (2.52 [1.71-3.72] and 10.68 [5.63-20.28]), defibrillations number (1.15 [1.07-1.23] and 1.15 [1.04-1.26]), and mechCPR (1.86 [1.17-2.96] and 2.06 [1.11-3.81]). With resuscitation times >13 min, mechCPR achieved more frequently ROSC compared to manCPR. Among ECLS patients, 70% had time exceeding protocol: 8 (7.5%) had CPC ≤2 (half of them with low-flow times between 45 and 90 min), 2 (1.9%) survived with severe neurological disabilities, and 13 brain-dead (12.0%) became organ donors.ConclusionsMechCPR patients achieved ROSC more frequently than manual CPR patients; mechCPR was a crucial factor in an ECLS protocol for refractory OHCA. ECLS offered a chance of survival to patients who would otherwise die.Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

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