EDECMO 19 – ECPR for Out-of-Hospital Cardiac Arrest Japanese-Style!

SakamotoTetsuya Sakamoto is the principal investigator of a multi-center prospective observational study comparing ECPR vs. traditional resuscitation for out of hospital cardiac arrest. His study was just recently published in the journal Resuscitation: Resuscitation. 2014 Jun;85(6):762-8. Zack and Joe met with Dr. Sakamoto during the 2014 AHA RESS conferences and talked all things ECPR.  After that, Shinar sat down with Dr. Sakamoto to get his take on how the Japanese EMS system is setup and how they are able to implement ECPR into their resuscitation protocols.

 

The Japanese Emergency Care System

  • Ambulance Crew = 1 EMT paramedic + 2 EMT's
    • EMT paramedic
      • Epi
      • Intubate
    • 2 Basic-trained EMT's
  • Hospital Systems:
    • General Hospital
    • Tertiary Hospital Receiving Centers (271 Centers)
      • Trauma
      • Resuscitation
      • Critical Care
  • Emergency Department at Japanese Tertiary Care Center
    • Emergency ICU
    • Trauma resuscitation, PCI, etc.
  • Pre-hospital protocols for Termination of Resuscitation protocols in Japan
    • In Japan, prehospitals providers are not empowered to pronounce
    • Average time on Scene = 10-20 min (scoop and run!)
    • They transport everyone!

Percutaneous Cardiopulmonary Support (ECMO) and the Save-J team

Final Thoughts

  • ECPR has huge promise for saving the lives of patients who would otherwise not survive with standard ACLS. But the cost is not trivial. So,
    1. we need to drill down into the inclusion criterion to ensure we are using this therapy on patients who will gain the most benefit.
    2. ECPR requires a team-approach, much like a trauma team activation.  The successful ECPR team still demands good-quality chest compressions, appropriate use of ACLS protocols, etc.
    3. Training is important because cannulation during arrest is tough.
  •  The Save-J approach to cannulation:   much like we do it here in the US, ultrasound-guided percutaneous approach is usually the go-to approach, with cut-down used as a rescue intervention.
*The EDECMO authors would like to thank Tetsuya Sakamoto for joining us on this episode of the EDECMO podcast and allowing us to share his thoughts on ECPR.

 

…No sex, no drugs, no wine, no women, no fun, no sin, no you, no wonder its dark…

~The Vapors (1980)

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