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. 2024 Nov;84(5):560-569.
doi: 10.1016/j.annemergmed.2024.01.005. Epub 2024 Feb 6.

Implementation of Extracorporeal CPR Programs for Out-of-Hospital Cardiac Arrest: Another Tale of Two County Hospitals

Anna Condella  1 , Nicholas S Simpson  2 , Kyle S Bilodeau  3 , Barclay Stewart  3 , Samuel Mandell  4 , Mark Taylor  5 , Beth Heather  6 , Eileen Bulger  3 , Nicholas J Johnson  7 , Matthew E Prekker  8
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Implementation of Extracorporeal CPR Programs for Out-of-Hospital Cardiac Arrest: Another Tale of Two County Hospitals

Anna Condella et al. Ann Emerg Med. 2024 Nov.

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is a form of intensive life support that has seen increasing use globally to improve outcomes for patients who experience out-of-hospital cardiac arrest (OHCA). Hospitals with advanced critical care capabilities may be interested in launching an ECPR program to offer this support to the patients they serve; however, to do so, they must first consider the significant investment of resources necessary to start and sustain the program. The existing literature describes many single-center ECPR programs and often focuses on inpatient care and patient outcomes in hospitals with cardiac surgery capabilities. However, building a successful ECPR program and using this technology to support an individual patient experiencing refractory cardiac arrest secondary to a shockable rhythm depends on efficient out-of-hospital and emergency department (ED) management. This article describes the process of implementing 2 intensivist-led ECPR programs with limited cardiac surgery capability. We focus on emergency medical services and ED clinician roles in identifying patients, mobilizing resources, initiation and management of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the ED, and ongoing efforts to improve ECPR program quality. Each center experienced a significant learning curve to reach goals of arrest-to-flow times of cannulation for ECPR. Building consensus from multidisciplinary stakeholders, including out-of-hospital stakeholders; establishing shared expectations of ECPR outcomes; and ensuring adequate resource support for ECPR activation were all key lessons in improving our ECPR programs.

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Figures

Figure 1.
Figure 1.
Time from cardiac arrest to ECMO flow initiation in Harborview ECPR cases from 2017 to 2019 in chronologic order.
Figure 2.
Figure 2.
Time from cardiac arrest to ECMO flow initiation in Hennepin ECPR cases from 2018 to 2020 in chronologic order.
Figure 3.
Figure 3.
Implementation map of required resources for an ECPR program.
See this image and copyright information in PMC

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