76: Netherlands Pre-Hospital ECPR Program

The Netherlands has undertaken a monumental task: provide ECPR to 100% of their country.  Dinis Reis Miranda and his team have put in place an unbelievably organized and robust project to improve the survival from cardiac arrest for their entire country.  Listen to Dinis explain about the project, their struggles, and this world changing experiment going on right now in the Netherlands.


Here is their projects website and some of its content – https://onscenetrial.com/






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  1. I am just a citizen and this just fascinates me, especially what advanced interventions these trauma teams do overall, like prehospital thoracotomies and amputations. With this comment, I actually want to point to the INCEPTION trial I mention in the last paragraph of this comment. I came across the On-Scene Trial a while ago on the news. Last month the second team joined the eCPR arm of the trial. It seems like they are behind the cCPR arm of the trial due to problems with the participation of EMS agencies in the Amsterdam lifeliner team (the last team to join eCPR). And the second team now doing eCPR also joined the cCPR later than planned.

    OHCA is a fairly big deal in The Netherlands already, and the survival rates have been quite high. EuReCa One trial (data from 2014) showed an Utstein OHCA survival rate of nearly 60% in The Netherlands. There have been large projects with a public/citizen dispatch system to decrease the time until AED and CPR. The results of such a system and the survival rates could be seen in the 6 January 2022 paper “Improved ROSC rates in out-of-hospital cardiac arrest patients after introduction of a text message alert system for trained volunteers”. So the study is built on an already great foundation of OHCA survival and care.

    The coverage area (100% of land area) and the time they can get patients on ECMO are great. But it comes at the cost of limited eCPR capacity by only accepting <50 patients. Wider criteria would only be possible if there would be more such teams and more ECMO hospital capacity. But with how common OHCA sadly is, you probably would be better off with more numerous special cardiac/ECMO teams and HEMS for all the other calls these 4 HEMS teams already do (13,000 per year over the 4 teams). Keep in mind, they also respond by car when the helicopter can't be used of when they are very close by.

    They seem to be actively considering a 5th team in the east for better coverage in that region. It is a spot that each team can just reach, at the limits of their response times, and is mainly serviced by a German HEMS team that is moving away further from the border. That could give the possibility of slightly more forgiving inclusion criteria.

    However, for patients not meeting the inclusion criteria, there is always ECMO-ED which hold wider inclusion criteria (50 and <70 meeting the other criteria of smaller cities and rural areas could not be covered, but that is still a large chunk of the population. This is the Early Initiation of Extracorporeal Life Support in Refractory OHCA (INCEPTION) and has been running since May 1, 2017. The primary completion date was February 10, 2021 and the study completion date was February 10, 2022. No results have been published yet, but it might be an interesting study to interview the people behind the project about it.

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