The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes

Abstract

Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). Methods: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18À75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS TM ), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit. Findings: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 § 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31À56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2.

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

“…It can be initiated safely in the cardiac catheterization laboratory by experienced interventional cardiologists with very short door to support time, even during ongoing cardiopulmonary resuscitation (CPR) ( 55 , 56 ). Depending on local institutional policies and the specific clinical scenario, it may also be instituted in the field (mobile ECMO programs), at bedside in the ICU, or in the operating room ( 57 ). Full VA-ECMO support not only allows time to perform diagnostic and therapeutic interventions while maintaining appropriate hemodynamics and gas exchange, but also provides time for potential organ recovery.…”

Außerklinische Reanimation: Wo stehen wir heute?

“…Verfahrens. Diese beschreibt das Erreichen eines ROSC durch Implantation einer extrakorporalen Kreislaufunterstützung (VA-ECMO) unter laufender Reanimation [18]. In einzelnen Regionen besteht die Möglichkeit, dass bereits präklinisch eine VA-ECMO implantiert wird.…”

“…Alternativ erfolgt nach Entscheidung zur ECPR der schnellstmögliche Transport in ein Zentrum mit VA-ECMO-Möglichkeit. In Zukunft wird die Möglichkeit der ECPR sicher noch breiter angewendet werden, aktuelle Studien zeigen erste positive Signale [18]. Aufgrund der Invasivität des Verfahrens sollten Patienten mit Bedacht ausgesucht werden.…”

Assessing need for extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest using Power BI for data visualisation

“…The provision of an ECPR service for OHCA requires a community-wide reconfiguration of pre-hospital and hospital systems to facilitate timecritical transfer of suitable patients to an ECPR-capable centre. 8,21 Assessing the number of patients who might reasonably qualify for ECPR during OHCA is critical to the planning and implementation of an ECPR service.…”