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Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest.

Abstract

INTRODUCTION

Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation.

AIMS

The aim of our protocol was to demonstrate that an ECPR team was feasible within our healthcare system and that the identification of UPMC Presbyterian as a receiving center allowed for successful treatment within 30 min from EMS dispatch.

METHODS

We developed out of hospital cardiac arrest (OHCA) ECPR protocols for Emergency Medical Services (EMS), EMS communications, and our in-hospital ECPR team. Inclusion criteria indentified patients with a potentially reversible arrest etiology and high probability of recoverable brain injury using a simple checklist: witnessed collapse, layperson CPR, initial shockable rhythm, and age 18-60 years. We trained local EMS crews to screen patients and reviewed the criteria with a Medic Command Physician prior to transport to our hospital.

RESULTS

From October 2015 to March 31st 2018, EMS treated 1165 EMS OHCA cases, transported 664 (57%) to a local hospital, and transported 120 (10%) to our institution. Of these, five (4.1%) patients underwent ECPR. Among excluded cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. For ECPR cases, median pre-hospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) received mechanical CPR. Interval from arrest to arrival on scene was 5 [IQR 4-6] min and interval from radio call to activation of ECPR was 13 [IQR 7-21] min. Interval from EMS dispatch to departure from scene was 20 [IQR 19-21] min. Time from EMS dispatch to initiation of ECPR was 63 [IQR 59-69] min.

CONCLUSIONS

ECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation.

Authors+Show Affiliations

University of Pittsburgh, Department of Medicine, Divison of Cardiology, United States. Electronic address: meshe.chonde@gmail.com.University of Pittsburgh, Department of Emergency Medicine, United States.University of Pittsburgh, Department of Emergency Medicine, United States; University of Pittsburgh, Department of Critical Care Medicine, United States.University of Pittsburgh, Department of Emergency Medicine, United States.University of Pittsburgh, Department of Emergency Medicine, United States.University of Pittsburgh, Department of Critical Care Medicine, United States.University of Pittsburgh, Department of Critical Care Medicine, United States.University of Pittsburgh, Department of Medicine, Divison of Cardiology, United States.University of Pittsburgh, Department of Medicine, Divison of Cardiology, United States.University of Pittsburgh, Department of Cardiothoracic Surgery, United States.University of Pittsburgh, Department of Cardiothoracic Surgery, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31887368

Citation

Chonde, Meshe, et al. "Challenges in the Development and Implementation of a Healthcare System Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Program for the Treatment of Out of Hospital Cardiac Arrest." Resuscitation, 2019.
Chonde M, Escajeda J, Elmer J, et al. Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest. Resuscitation. 2019.
Chonde, M., Escajeda, J., Elmer, J., Callaway, C. W., Guyette, F. X., Boujoukos, A., ... Kormos, R. L. (2019). Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest. Resuscitation, doi:10.1016/j.resuscitation.2019.12.015.
Chonde M, et al. Challenges in the Development and Implementation of a Healthcare System Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Program for the Treatment of Out of Hospital Cardiac Arrest. Resuscitation. 2019 Dec 27; PubMed PMID: 31887368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest. AU - Chonde,Meshe, AU - Escajeda,Jeremiah, AU - Elmer,Jonathan, AU - Callaway,Clifton W, AU - Guyette,Frank X, AU - Boujoukos,Arthur, AU - Sappington,Penny L, AU - Smith,Anson J, AU - Schmidhofer,Mark, AU - Sciortino,Christopher, AU - Kormos,Robert L, Y1 - 2019/12/27/ PY - 2019/04/11/received PY - 2019/12/12/revised PY - 2019/12/17/accepted PY - 2019/12/31/pubmed PY - 2019/12/31/medline PY - 2019/12/31/entrez KW - Cardiac arrest KW - Emergency medical services KW - Extracorporeal cardiopulmonary resuscitation (ECPR) JF - Resuscitation JO - Resuscitation N2 - INTRODUCTION: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation. AIMS: The aim of our protocol was to demonstrate that an ECPR team was feasible within our healthcare system and that the identification of UPMC Presbyterian as a receiving center allowed for successful treatment within 30 min from EMS dispatch. METHODS: We developed out of hospital cardiac arrest (OHCA) ECPR protocols for Emergency Medical Services (EMS), EMS communications, and our in-hospital ECPR team. Inclusion criteria indentified patients with a potentially reversible arrest etiology and high probability of recoverable brain injury using a simple checklist: witnessed collapse, layperson CPR, initial shockable rhythm, and age 18-60 years. We trained local EMS crews to screen patients and reviewed the criteria with a Medic Command Physician prior to transport to our hospital. RESULTS: From October 2015 to March 31st 2018, EMS treated 1165 EMS OHCA cases, transported 664 (57%) to a local hospital, and transported 120 (10%) to our institution. Of these, five (4.1%) patients underwent ECPR. Among excluded cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. For ECPR cases, median pre-hospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) received mechanical CPR. Interval from arrest to arrival on scene was 5 [IQR 4-6] min and interval from radio call to activation of ECPR was 13 [IQR 7-21] min. Interval from EMS dispatch to departure from scene was 20 [IQR 19-21] min. Time from EMS dispatch to initiation of ECPR was 63 [IQR 59-69] min. CONCLUSIONS: ECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/31887368/Challenges_in_the_development_and_implementation_of_a_healthcare_system_based_extracorporeal_cardiopulmonary_resuscitation_(ECPR)_program_for_the_treatment_of_out_of_hospital_cardiac_arrest L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(19)30738-5 DB - PRIME DP - Unbound Medicine ER -