. 2020 Nov 13;3(3):327-336.

doi: 10.1016/j.cjco.2020.11.005. eCollection 2021 Mar.

Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada

Brian Grunau¹, Sam D Shemie^{2

3}, Lindsay C Wilson³, Katie N Dainty^{4

5}, Dave Nagpal⁶, Laura Hornby^{3

7}, Yoan Lamarche⁸, Sean van Diepen⁹, Hussein D Kanji¹⁰, James Gould¹¹, Richard Saczkowski¹², Steven C Brooks¹³

Affiliations

¹ Department of Emergency Medicine and Centre for Health Evaluation and Outcome Sciences, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.
² Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada.
³ Deceased Donation, Canadian Blood Services, Ottawa, Ontario, Canada.
⁴ Patient-Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada.
⁵ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁶ Divisions of Cardiac Surgery and Critical Care Medicine, Western University, London, Ontario, Canada.
⁷ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁸ Divisions of Cardiac Surgery and Critical Care Medicine, University of Montreal, Montreal, Quebec, Canada.
⁹ Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹⁰ Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹¹ Department of Emergency Medicine, Dalhousie University, Saint John, New Brunswick, Canada.
¹² Division of Cardiac Surgery, Kelowna General Hospital, Kelowna, British Columbia, Canada.
¹³ Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.

PMID: 33778449
PMCID: PMC7985000
DOI: 10.1016/j.cjco.2020.11.005

Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada

Brian Grunau et al. CJC Open. 2020.

. 2020 Nov 13;3(3):327-336.

doi: 10.1016/j.cjco.2020.11.005. eCollection 2021 Mar.

Authors

Affiliations

¹ Department of Emergency Medicine and Centre for Health Evaluation and Outcome Sciences, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.
² Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada.
³ Deceased Donation, Canadian Blood Services, Ottawa, Ontario, Canada.
⁴ Patient-Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada.
⁵ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁶ Divisions of Cardiac Surgery and Critical Care Medicine, Western University, London, Ontario, Canada.
⁷ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁸ Divisions of Cardiac Surgery and Critical Care Medicine, University of Montreal, Montreal, Quebec, Canada.
⁹ Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹⁰ Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹¹ Department of Emergency Medicine, Dalhousie University, Saint John, New Brunswick, Canada.
¹² Division of Cardiac Surgery, Kelowna General Hospital, Kelowna, British Columbia, Canada.
¹³ Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.

PMID: 33778449
PMCID: PMC7985000
DOI: 10.1016/j.cjco.2020.11.005

Abstract
in English, French

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a therapeutic option for refractory cardiac arrest. We sought to perform an environmental scan to describe ECPR utilization in Canada and perceived barriers for application to out-of-hospital cardiac arrest (OHCA).

Methods: This was a national cross-sectional study. We identified all cardiovascular surgery- and extracorporeal membrane oxygenation (ECMO)-capable hospitals in Canada and emergency medical services (EMS) agencies delivering patients to those centres. We requested the medical lead from each hospital's ECMO service and each EMS agency to submit data regarding ECMO and ECPR utilization, as well as perceived barriers to ECPR provision for OHCA.

Results: We identified and received survey data from 39 of 39 Canadian hospital institutions and 21 of 22 EMS agencies. Of hospitals, 38 (97%) perform ECMO and 27 (69%) perform ECPR (74% of which perform ≤5 cases per year). Of the 18 (46%) sites offering ECPR for OHCA, 8 apply a formal protocol for eligibility and initiation procedures. EMS agencies demonstrate heterogeneity with intra-arrest transport practices. The primary rationale for nontransport of refractory OHCA is that hospital-based care offers no additional therapies. Perceived barriers to the use of ECPR for OHCA were primarily related to limited evidence supporting its use, rather than resources required.

Conclusion: Many Canadian cardiovascular surgery- or ECMO-equipped hospitals use ECPR; roughly half employ ECPR for OHCAs. Low case volumes and few formal protocols indicate that this is not a standardized therapy option in most centres. Increased application may be dependent on a stronger evidence base including data from randomized clinical trials currently underway.

Contexte: La réanimation cardiorespiratoire (RCR) extracorporelle est une option thérapeutique en cas d'arrêt cardiaque réfractaire. Nous avons voulu faire une analyse contextuelle de l'utilisation de la RCR extracorporelle au Canada et des obstacles perçus quant à son emploi dans les cas d'arrêt cardiaque en dehors de l'hôpital.

Méthodologie: Il s’agissait d’une étude nationale transversale. Nous avons repéré tous les hôpitaux en mesure d'effectuer des chirurgies cardiovasculaires et d'offrir l'oxygénation extracorporelle au Canada et les fournisseurs de services médicaux d'urgence (SMU) transportant les patients vers ces centres. Nous avons demandé au chef médical du service d'oxygénation extracorporelle de chacun des hôpitaux et de chacun des fournisseurs de SMU de présenter leurs données concernant l'utilisation de l'oxygénation extracorporelle et de la RCR extracorporelle, ainsi que les obstacles perçus quant à l'emploi de la RCR extracorporelle dans les cas d'arrêt cardiaque en dehors de l'hôpital.

Résultats: Nous avons obtenu les données de 39 des 39 établissements hospitaliers canadiens ciblés, et de 21 des 22 fournisseurs de SMU. Parmi les hôpitaux, 38 (97%) utilisent l'oxygénation extracorporelle et 27 (69 %), la RCR extracorporelle (74 % ayant eu recours à celle-ci dans ≤ 5 cas par année). Parmi les 18 (46 %) centres offrant la RCR extracorporelle en cas d'arrêt cardiaque en dehors de l'hôpital, 8 appliquaient un protocole officiel pour l'admissibilité et les procédures de mise en place. Les fournisseurs de SMU ont montré des pratiques hétérogènes concernant la réanimation en déplacement. La principale raison justifiant de ne pas transporter les patients présentant un arrêt cardiaque réfractaire en dehors de l'hôpital est que les soins en milieu hospitalier n'offrent pas de traitements additionnels. Les obstacles perçus quant à l'emploi de la RCR extracorporelle dans les cas d'arrêt cardiaque en dehors de l'hôpital étaient principalement liés au peu de données appuyant son utilisation, plutôt qu'aux ressources nécessaires.

Conclusion: De nombreux hôpitaux canadiens équipés pour la chirurgie cardiovasculaire et l'oxygénation extracorporelle utilisent la RCR extracorporelle; environ la moitié d'entre eux utilisent la RCR extracorporelle en cas d'arrêt cardiaque en dehors de l'hôpital. Le faible nombre de cas et le peu de protocoles officiels indiquent qu'il ne s'agit pas d'une option de traitement standardisée dans la plupart des centres. Une utilisation plus fréquente pourrait nécessiter davantage de données probantes, y compris les résultats des études cliniques à répartition aléatoire qui sont en cours.

PubMed Disclaimer

Figures

**Figure 1**
Proportion of hospital respondents who classified the barrier as “moderate” to “very large” overall and comparing sites performing 0-2 and ≥ 3 ECPR cases per year. ∗Denotes a difference between the results of sites performing 0-2 ECPR cases per year and the sites performing ≥ 3 ECPR cases per year. ECMO, extracorporeal membrane oxygenation; ECPR, extracorporeal cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest.

**Figure 2**
Proportion of emergency medical system (EMS) respondents who classified the barrier as “moderate” to “very large.” ECPR, extracorporeal cardiopulmonary resuscitation; EMT, emergency medical technician.

See this image and copyright information in PMC

Cited by

RADAR-ES: A Methodological Framework for Conducting Environmental Scans in Health Services Delivery Research.
Nagel DA, Charlton P, Azar R, Koenig L, Burns K, Kean T. Nagel DA, et al. J Prim Care Community Health. 2025 Jan-Dec;16:21501319251363783. doi: 10.1177/21501319251363783. Epub 2025 Aug 17. J Prim Care Community Health. 2025. PMID: 40819256 Free PMC article.
Implications of the updated Canadian Death Determination Guidelines for organ donation interventions that restore circulation after determination of death by circulatory criteria.
Murphy NB, Weijer C, Slessarev M, Chandler JA, Gofton T. Murphy NB, et al. Can J Anaesth. 2023 Apr;70(4):591-595. doi: 10.1007/s12630-023-02413-6. Epub 2023 May 2. Can J Anaesth. 2023. PMID: 37131028 Free PMC article. No abstract available.
Clinicians' experience of barriers and facilitators to care delivery of an extracorporeal cardiopulmonary resuscitation service for out-of-hospital cardiac arrest: a qualitative survey.
Eddison J, Millerchip O, Rosenberg A, Lewinsohn A, Raitt J. Eddison J, et al. Scand J Trauma Resusc Emerg Med. 2024 Sep 13;32(1):86. doi: 10.1186/s13049-024-01261-7. Scand J Trauma Resusc Emerg Med. 2024. PMID: 39272171 Free PMC article.
CEPP: Canadian Extracorporeal Life Support (ECLS) Protocol Project.
Fagan A, Grunau B, Caddell A, Gould J, Rayner-Hartley E, Lamarche Y, Singh G, Nagpal D, Slessarev M. Fagan A, et al. CJC Open. 2022 Feb 15;4(6):520-531. doi: 10.1016/j.cjco.2022.02.005. eCollection 2022 Jun. CJC Open. 2022. PMID: 35734512 Free PMC article.

References

1. Mozaffarian D., Benjamin E.J., Go A.S. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–360. - PubMed
1. Grunau B., Scheuermeyer F.X., Stub D. Potential candidates for a structured Canadian ECPR program for out-of-hospital cardiac arrest. CJEM. 2016;18:453–460. - PubMed
1. Panchal A.R., Berg K.M., Hirsch K.G. 2019 American Heart Association focused update on advanced cardiovascular life support: use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest: an update to the American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2019;140:e881–e894. - PubMed
1. Avalli L., Maggioni E., Formica F. Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience. Resuscitation. 2012;83:579–583. - PubMed
1. Wengenmayer T., Rombach S., Ramshorn F. Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR) Crit Care. 2017;21:157. - PMC - PubMed

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada

Affiliations

Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada

Authors

Affiliations

Abstract
in English, French

Figures

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources

Other Literature Sources

Abstract in English, French

Figures

Similar articles

Cited by

References

Related information

LinkOut - more resources

Full Text Sources

Other Literature Sources

Abstract
in English, French