Implementation of a regional extracorporeal membrane oxygenation program for refractory ventricular fibrillation out-of-hospital cardiac arrest

Nichole Bosson; Clayton Kazan; Stephen Sanko; Tiffany Abramson; Marc Eckstein; David Eisner; Joel Geiderman; Walid Ghurabi; Vadim Gudzenko; Anil Mehra; Sam Torbati; Atilla Uner; Marianne Gausche-Hill; David Shavelle

doi:10.1016/j.resuscitation.2023.109711

Implementation of a regional extracorporeal membrane oxygenation program for refractory ventricular fibrillation out-of-hospital cardiac arrest

Resuscitation. 2023 Jun:187:109711. doi: 10.1016/j.resuscitation.2023.109711. Epub 2023 Jan 30.

Authors

Nichole Bosson¹, Clayton Kazan², Stephen Sanko³, Tiffany Abramson⁴, Marc Eckstein⁴, David Eisner⁵, Joel Geiderman⁶, Walid Ghurabi⁷, Vadim Gudzenko⁸, Anil Mehra⁴, Sam Torbati⁹, Atilla Uner⁸, Marianne Gausche-Hill¹⁰, David Shavelle¹¹

Affiliations

¹ Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, 1000 W Carson Street, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. Electronic address: nbosson@dhs.lacounty.gov.
² Los Angeles County Fire Department, 1320 N. Eastern Avenue, Los Angeles, CA 90063, USA.
³ Los Angeles County-USC Medical Center, Department of Emergency Medicine, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA 90033, USA; Los Angeles Fire Department, 200 N Main Street, Los Angeles, CA 90012, USA.
⁴ Los Angeles County-USC Medical Center, Department of Emergency Medicine, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
⁵ Culver City Fire Department, 9770 Culver Blvd, Culver City, CA 90232, USA.
⁶ Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA; Beverly Hills Fire Department, 445 N Rexford Dr., Beverly Hills, CA 90210, USA.
⁷ David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Santa Monica Fire Department, 333 Olympic Blvd, Santa Monica, CA 90401, USA.
⁸ David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Ronald Reagan UCLA Medical Center, Department of Emergency Medicine, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
⁹ Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
¹⁰ Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, 1000 W Carson Street, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
¹¹ MemorialCare Heart and Vascular Institute (MHVI), Long Beach Medical Center, 2801 Atlantic Ave, Long Beach, CA 90807, USA.

PMID: 36720300
DOI: 10.1016/j.resuscitation.2023.109711

Abstract

Background: eCPR, the modality of extracorporeal membrane oxygenation (ECMO) applied in the setting of cardiac arrest, has emerged as a novel therapy which may improve outcomes in select patients with out-of-hospital cardiac arrest (OHCA). To date, implementation has been mainly limited to single academic centres. Our objective is to describe the feasibility and challenges with implementation of a regional protocol for eCPR.

Methods: The Los Angeles County Emergency Medical Services (EMS) Agency implemented a regional eCPR protocol in July 2020, which included coordination across multiple EMS provider agencies and hospitals to route patients with refractory ventricular fibrillation (rVF) OHCA to eCPR-capable centres (ECCs). Data were entered on consecutive patients with rVF with suspected cardiac aetiology into a centralized database including time intervals, field and in-hospital care, survival and neurologic outcome.

Results: From July 27, 2020 through July 31, 2022, 35 patients (median age 57 years, 6 (17%) female) were routed to ECCs, of whom 11 (31%) received eCPR and 3 (27%) treated with eCPR survived, all of whom had a full neurologic recovery. Challenges encountered during implementation included cost to EMS provider agencies for training, implementation, and purchase of automatic chest compression devices, maintenance of system awareness, hospital administrative support for staffing and equipment for the ECMO program, and interdepartmental coordination at ECCs.

Conclusion: We describe the successful implementation of a regional eCPR program with ongoing patient enrolment and data collection. These preliminary findings can serve as a model for other EMS systems who seek to implement regional eCPR programs.

Keywords: Out-of-hospital cardiac arrest; emergency medical services; extracorporeal membrane oxygenation.

MeSH terms

Cardiopulmonary Resuscitation* / methods
Emergency Medical Services* / methods
Extracorporeal Membrane Oxygenation* / methods
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest*
Retrospective Studies
Ventricular Fibrillation / complications
Ventricular Fibrillation / therapy