.jpg "Matthew Stampfl, MD photo")
Daniel McCarthy, MD MBA
Assistant Professor
University of Wisconsin-UW Health, United States
Disclosure information not submitted.
Jillian Koch, RRT
ECMO Coordinator
University of Wisconsin-UW Health, United States
Disclosure information not submitted.
Michael Lohmeier, MD
Associate Professor
Unversity of Wisconsin-UW Health, United States
Disclosure information not submitted.
Eric Anderson, NREMT-P
Data Analyst
Dane County Emergency Management, United States
Disclosure information not submitted.
Joshua Glazer, MD
Assistant Professor
University of Wisconsin-UW Health at The American Center, United States
Disclosure information not submitted.
Title: ECPR Prehospital Opportunities Identified through Geospatial Mapping
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) holds promise to improve outcomes for out-of-hospital cardiac arrest (OHCA) but requires careful patient selection, timely application, and rigorous quality assurance to be effective. Time-to-ECPR (TTE) of 60 minutes limits the low-flow state and is highly correlated with neuro-intact survival. Achieving this for OHCA requires close integration with EMS systems to achieve prompt transport and activation of hospital ECPR systems, ideally before the patient arrives.
Methods: Our tertiary academic medical center leverages a commercially-available geospatial mapping tool (ArcGIS) to generate a county-wide map displaying anticipated TTE based on location of the arrest. Local traffic patterns, historical EMS transport times, duration of on-scene resuscitation, and ED-to-cannulation time are integrated and modifiable. Approximate coordinates of ECPR scene calls, responding EMS agency, and patient outcome are superimposed on this map. Outcomes for ECPR patients were analyzed for actionable trends using this tool.
Results: Overall neuro-intact survival for patients receiving ECPR for OHCA since program inception is 27.3%. Prehospital activation of the ECPR process was involved in nearly all cannulations for OHCA (91%). Three different EMS agencies have successfully transported ECPR patients and neurologically intact survival has been achieved with transport times as long as 16 minutes. Geospatial mapping identified a cluster of cases close to our hospital with poorer than expected outcome, prompting additional analysis which demonstrated that transport time appears to be less impactful on outcomes than on-scene resuscitation time for patients accepted for ECPR (see separate abstract).
Conclusions: Our data demonstrates the necessity of EMS engagement for a successful ECPR program, as nearly all cases accepted for ECPR have involved prehospital activation due to our goal TTE of 60 minutes. Geospatial mapping with traffic and outcome data likewise reveal prehospital ECPR opportunities that may otherwise be inconspicuous. Next steps will include analysis of potential impact of mechanical versus manual compressions during transport.