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Eligibility of out-of-hospital cardiac arrest patients for extracorporeal cardiopulmonary resuscitation in the United States: A geographic information system model

  • Author Footnotes
    1 Department of Emergency Medicine and Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.
    Adam L. Gottula
    Correspondence
    Corresponding author at: 1500 East Medical Center Dr., 4172/Cardiovascular Center, Ann Arbor, MI 48109, United States.
    Footnotes
    1 Department of Emergency Medicine and Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.
    Affiliations
    Department of Emergency Medicine, University of Michigan, United States

    Department of Anesthesiology, University of Michigan, United States

    Max Harry Weil Institute for Critical Care Research and Innovation, United States
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  • Author Footnotes
    2 Department of Medicine, Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, United States.
    Christopher R. Shaw
    Footnotes
    2 Department of Medicine, Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, United States.
    Affiliations
    Department of Medicine Division of Pulmonary and Critical Care, Oregon Health and Science University, United States
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  • Author Footnotes
    3 The Christ Hospital, Cincinnati, OH, United States.
    Kari L. Gorder
    Footnotes
    3 The Christ Hospital, Cincinnati, OH, United States.
    Affiliations
    The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, United States
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  • Author Footnotes
    4 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States.
    Bennett H. Lane
    Footnotes
    4 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States.
    Affiliations
    Department of Emergency Medicine, University of Cincinnati, United States
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  • Author Footnotes
    5 Department of Planning, University of Cincinnati, Cincinnati, OH, United States.
    Jennifer Latessa
    Footnotes
    5 Department of Planning, University of Cincinnati, Cincinnati, OH, United States.
    Affiliations
    Department of Planning, The University of Cincinnati, United States
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  • Author Footnotes
    6 Department of Geography and Geographic Information System, University of Cincinnati, Cincinnati, OH, United States.
    Man Qi
    Footnotes
    6 Department of Geography and Geographic Information System, University of Cincinnati, Cincinnati, OH, United States.
    Affiliations
    Department of Geography and Geographic Information System, The University of Cincinnati, United States
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  • Author Footnotes
    7 University of Cincinnati, Cincinnati, OH, United States.
    Amy Koshoffer
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    7 University of Cincinnati, Cincinnati, OH, United States.
    Affiliations
    University of Cincinnati Libraries, The University of Cincinnati, United States
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  • Author Footnotes
    8 Department of Emergency Medicine, Emory University, Atlanta, GA, United States.
    Rabab Al-Araji
    Footnotes
    8 Department of Emergency Medicine, Emory University, Atlanta, GA, United States.
    Affiliations
    Department of Emergency Medicine, Emory University, United States

    The Cardiac Arrest Registry to Enhance Survival, United States
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  • Author Footnotes
    9 University of Cincinnati College of Medicine, Cincinnati, OH, United States.
    Wesley Young
    Footnotes
    9 University of Cincinnati College of Medicine, Cincinnati, OH, United States.
    Affiliations
    College of Medicine, The University of Cincinnati, United States
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  • Author Footnotes
    10 Departments of Emergency Medicine, Neurology and Neurosurgery, University of Cincinnati, Cincinnati, OH, United States.
    Jordan Bonomo
    Footnotes
    10 Departments of Emergency Medicine, Neurology and Neurosurgery, University of Cincinnati, Cincinnati, OH, United States.
    Affiliations
    Department of Emergency Medicine, University of Cincinnati, United States

    Department of Neurosurgery, University of Cincinnati, United States
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    11 Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Center, Houston, TX, United States.
    James R. Langabeer
    Footnotes
    11 Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Center, Houston, TX, United States.
    Affiliations
    Department of Emergency, Medicine McGovern School of Medicine, The University of Texas Health Center, United States

    UT School of Public Health, The University of Texas Health Center, United States

    School of Biomedical Informatics, The University of Texas Health Center, United States
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  • Author Footnotes
    12 Center for Resuscitation Medicine, The University of Minnesota, Minneapolis, MN, United States.
    Demetris Yannopoulos
    Footnotes
    12 Center for Resuscitation Medicine, The University of Minnesota, Minneapolis, MN, United States.
    Affiliations
    Center for Resuscitation Medicine, The University of Minnesota, United States
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  • Author Footnotes
    13 Medical Director, The Carl and Edyth Lindner Center for Research and Education the Christ Hospital, Cincinnati, OH, United States.
    Timothy D. Henry
    Footnotes
    13 Medical Director, The Carl and Edyth Lindner Center for Research and Education the Christ Hospital, Cincinnati, OH, United States.
    Affiliations
    The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, United States
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  • Author Footnotes
    14 Department of Emergency Medicine and Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
    Cindy H. Hsu
    Footnotes
    14 Department of Emergency Medicine and Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
    Affiliations
    Department of Emergency Medicine, University of Michigan, United States

    Max Harry Weil Institute for Critical Care Research and Innovation, United States

    Department of Surgery, University of Michigan, United States
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  • Author Footnotes
    15 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States.
    Justin L. Benoit
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    15 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States.
    Affiliations
    Department of Emergency Medicine, University of Cincinnati, United States
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  • Author Footnotes
    1 Department of Emergency Medicine and Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.
    2 Department of Medicine, Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, United States.
    3 The Christ Hospital, Cincinnati, OH, United States.
    4 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States.
    5 Department of Planning, University of Cincinnati, Cincinnati, OH, United States.
    6 Department of Geography and Geographic Information System, University of Cincinnati, Cincinnati, OH, United States.
    7 University of Cincinnati, Cincinnati, OH, United States.
    8 Department of Emergency Medicine, Emory University, Atlanta, GA, United States.
    9 University of Cincinnati College of Medicine, Cincinnati, OH, United States.
    10 Departments of Emergency Medicine, Neurology and Neurosurgery, University of Cincinnati, Cincinnati, OH, United States.
    11 Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Center, Houston, TX, United States.
    12 Center for Resuscitation Medicine, The University of Minnesota, Minneapolis, MN, United States.
    13 Medical Director, The Carl and Edyth Lindner Center for Research and Education the Christ Hospital, Cincinnati, OH, United States.
    14 Department of Emergency Medicine and Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
    15 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States.

      Abstract

      Background

      Recent evidence suggest that extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers.

      Methods

      We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. The combined model was used to estimate the total number of ECPR candidates.

      Results

      There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were deemed eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model.

      Conclusions

      Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies.

      Keywords

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