First Description of a Helicopter-Borne ECPR Team for Remote Refractory Out-of-Hospital Cardiac Arrest

Area of Science:

• Emergency Medicine
• Cardiovascular Surgery
• Critical Care

Background:

• Timely access to extracorporeal cardiopulmonary resuscitation (ECPR) is critical for patients with refractory out-of-hospital cardiac arrest (OHCA).
• Geographical distance to ECPR centers can exclude patients from this life-saving treatment.
• Developing strategies to extend ECPR accessibility is essential for improving patient outcomes.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of a helicopter-borne ECPR team for patients with OHCA located far from ECPR centers.
• To assess patient outcomes and key time metrics associated with this mobile ECPR strategy.
• To determine if a helicopter-borne ECPR team can improve equity of access to this advanced treatment.

Main Methods:

• A retrospective, single-center study was conducted.
• Data from 33 consecutive patients treated by a heliborne ECPR team between January 2014 and December 2017 were analyzed.
• Key characteristics, including cardiac arrest details, time intervals (no-flow, low-flow, dispatch times), and patient outcomes, were examined.

Main Results:

• The study included 33 patients, with a mean age of 43.9 years, and an average distance of 41 km from the ECPR base.
• The mean low-flow time was 110 minutes.
• Five patients survived with good neurological outcomes, and six patients became organ donors after brain death.

Conclusions:

• A helicopter-borne ECPR team can successfully extend ECPR accessibility to patients geographically distant from specialized centers.
• The observed survival rate is significant, particularly given the lack of alternative treatments for these critically ill patients.
• Earlier activation of the ECPR team may further reduce low-flow times and potentially improve survival rates, enhancing equity in ECPR access.