Abstract
Background
eCPR, the modality of extracorporeal membrane oxygenation (ECMO) applied in the setting
of cardiac arrest, has emerged as a novel therapy which may improve outcomes in select
patients with out-of-hospital cardiac arrest (OHCA). To date, implementation has been
mainly limited to single academic centres. Our objective is to describe the feasibility
and challenges with implementation of a regional protocol for eCPR.
Methods
The Los Angeles County Emergency Medical Services (EMS) Agency implemented a regional
eCPR protocol in July 2020, which included coordination across multiple EMS provider
agencies and hospitals to route patients with refractory ventricular fibrillation
(rVF) OHCA to eCPR-capable centres (ECCs). Data were entered on consecutive patients
with rVF with suspected cardiac aetiology into a centralized database including time
intervals, field and in-hospital care, survival and neurologic outcome.
Results
From July 27, 2020 through July 31, 2022, 35 patients (median age 57 years, 6 (17%)
female) were routed to ECCs, of whom 11 (31%) received eCPR and 3 (27%) treated with
eCPR survived, all of whom had a full neurologic recovery. Challenges encountered
during implementation included cost to EMS provider agencies for training, implementation,
and purchase of automatic chest compression devices, maintenance of system awareness,
hospital administrative support for staffing and equipment for the ECMO program, and
interdepartmental coordination at ECCs.
Conclusion
We describe the successful implementation of a regional eCPR program with ongoing
patient enrolment and data collection. These preliminary findings can serve as a model
for other EMS systems who seek to implement regional eCPR programs.
Keywords
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References
- Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.Circulation. 2021; 143: e254-e743
- The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis.Crit Care. 2020; 24: 61
- Trend analysis of disability-adjusted life years following adult out-of-hospital cardiac arrest in the United States: A study from the CARES Surveillance Group.Resuscitation. 2021; 163: 124-129
- ECPR may be the most effective intervention for refractory cardiac arrest-ever.Resuscitation. 2022; 179: 18-20
- Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: Critical care and extracorporeal membrane oxygenation management.Resuscitation. 2018; 132: 47-55
- A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis.Resuscitation. 2017; 117: 109-117
- Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.JAMA. 2022; 327: 737-747
- Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial.Lancet. 2020; 396: 1807-1816
- Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: A systematic review.Resuscitation. 2018; 130: 146-158
- ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years.Resuscitation. 2017; 112: 34-40
- Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications.Intensive Care Med. 2022; 48: 1-15
- Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest.Resuscitation. 2020; 148: 259-265
- A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest.Resuscitation. 2021; 167: 22-28
- Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport.Ann Emerg Med. 2021; 78: 92-101
- ECPR(2): Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation.Resuscitation. 2022;
- Survival and neurologic outcome after out-of-hospital cardiac arrest: results one year after regionalization of post-cardiac arrest care in a large metropolitan area.Prehosp Emerg Care. 2014; 18: 217-223
County of Los Angeles, Department of Health Services. Treatment Protocol 1210: Cardiac Arrest. Accessed August 14, 2022. https://file.lacounty.gov/SDSInter/dhs/1040387_1210CardiacArrest2018-05-30.pdf.
Article info
Publication history
Published online: January 28, 2023
Accepted:
January 23,
2023
Received in revised form:
January 7,
2023
Received:
November 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
