First Prehospital-ECMO Initiation Abstract Just Published

My friend Bri Burns sent me this abstract this morning:

Thorac cardiovasc Surg 2013; 61 – P45 (DOI: 10.1055/s-0032-1332685)

Pre-hospital cardiopulmonary resuscitation supported by ECMO – a case series of 6 patients

M Hilker, A Philip, M Arlt, M Amann, D Lunz, T Müller, M Zimmermann, B Graf , C Schmid

  • Universitätsklinikum Regensburg, Regensburg, Germany

Objectives: Manual cardiopulmonary resuscitation (CPR) or automated CPR with chest compression systems are currently the standard treatments for cardiac arrest patients out of the hospital. There is a strong clinical evidence that rapid onset of ECMO in patients with cardiocirculatory failure can improve survival during in-hospital resuscitation. In contrast to these findings out-of-hospital cardiac arrest patients cannulated in the emergency room show a poor outcome.

Our aim is to shorten the „time-to-pump“ by initiation of the ECMO system on scene with safe transportation under stable hemodynamics. Therefore this case series of 6 patients demonstrate our first “real life” experience with this approach.

Methods: In the last two years (from September 2010 to 2012), ECMO was installed in 6 patients on scene by an interdisciplinary team. All patients who met the following citeria were included. 1. witnessed cardiac arrest; 2. refractory cardiac arrest; 3. a mobile ECMO team was available; 5. a lack of known, severe comorbidities; 6. age < 70 years.

Results: The results are subsumed in the following table.

Table 1: Patient data and Outcome
case years, gender location of ECMO implantation time to pump (min) diagnosis subsequet intervention outcome
1 11, f swimming lake 50 drowning CT dead, global brain ischemia
2 44, f apartment 90 PE CT dead, global brain ischemia
3 50, m doctor’s office 55 AMI PCI, CT dead, global brain ischemia
4 53, m apartment 53 PE none dead on scene
5 52, m apartment 67 AMI DCI, CT persistent neurological deficit
6 57, m place of work 50 AMI PCI, CT alive without deficit

Conclusion: To the best of our knowledge, this is the first case series that shows not only the feasibility of implantation of ECMO on scene for refractory cardiac arrest but also the successful application of this approach. The holy grail is now to identify patients in advance who will suffer irreversible cerebral anoxia.

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Dominic Larose
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There is a group in France that also published.

Dr Lamhaut et al. Safety and feasability of prehospital extracorporeal life support implementation by non surgeons for out of hospital refractory cardiac arrest. Resuscitation 84(2013) 1525-1529. They describe 1/7 patient with an excellent outcome.

They published a case report in 2012
See picture:
https://drive.google.com/file/d/0BwGMUQkj6uL_aUwxbjBRYzFhelU/edit?usp=sharing

Dominic Larose MD FACEP
Institut de Cardiologie de Montréal

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