.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: On-Scene Resuscitation Time is Highly Correlated with Neuro-Intact Survival for ECPR
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 or less limits the low-flow state and is highly correlated with neurologically-intact survival. Previous data suggests that on-scene conventional CPR has diminishing returns after 16 minutes. Importantly, this cutoff allows sufficient time for transport and cannulation to facilitate TTE of < 60 minutes.
Methods: Our institutional ECPR registry is generated via a novel electronic health record-embedded tool and geospatial mapping of these cases identified that outcomes did not appear to correspond with distance from the hospital (see separate abstracts). All ECPR cases and associated EMS run-sheets were manually reviewed for timestamps (e.g. 911 call, EMS arrival, ED arrival, cannulation, and goal flow on ECMO). From these, discrete phases of ECPR care were extrapolated: 911-to-scene, on-scene resuscitation, EMS transport, ED-arrival-to-cannulation, and overall TTE. This data was then compared against patient outcomes, including survival and neuro-intact survival (CPC 1 or 2).
Results: Overall neuro-intact survival for patients receiving ECPR for OHCA since program inception is 27.3%. Mean EMS duration on-scene for OHCA patients who received ECPR and survived to discharge was 16.3 minutes vs 25.6 minutes in patients who did not survive (p=0.0489). 911-to-scene, EMS transport, ED-arrival-to-cannulation, and overall TTE did not differ significantly between the groups.
Conclusions: Analysis of our ECPR population provides additional evidence supporting the previously proposed 16 minutes on-scene resuscitation as an ideal cutoff which balances the risks and benefits of early versus later transport. We suspect the non-significance of TTE is a function of our ECPR candidacy protocols, in which patients are declined if they cannot be placed onto ECMO within the target time period. Limiting EMS on-scene time may be the most impactful and modifiable interval associated with ECPR survival. As such, institutions seeking to implement ECPR must liaise closely with local EMS and provide guidance regarding timing of prehospital resuscitative efforts.