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ECPR Survivor Estimates: A Simulation-Based Approach to Comparing ECPR Delivery Strategies
Natalie Kruit1,2,3, Changle Song4, David Tian2,5
1Sydney Medical School, University of Sydney, Sydney, Australia.
Prehospital Emergency Care
|June 26, 2023
Summary
Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) could significantly improve survival for out-of-hospital cardiac arrest (OHCA) patients. An optimally located ECPR service could save one additional life for every 3.0 patients compared to conventional CPR.
Area of Science:
- Emergency Medicine
- Cardiovascular Research
- Public Health
Background:
- The number of out-of-hospital cardiac arrest (OHCA) patients eligible for prehospital extracorporeal cardiopulmonary resuscitation (ECPR) remains unclear.
- Patient eligibility for ECPR depends on case specifics and proximity to specialized services.
- Accessibility principles applied to historical data can estimate potential ECPR benefit.
Purpose of the Study:
- To determine the number of OHCA patients in Sydney, Australia, eligible for prehospital ECPR.
- To assess the potential survival benefit of a hypothetical prehospital ECPR service.
- To evaluate the impact of transport accessibility on ECPR service delivery.
Main Methods:
- Retrospective analysis of 39,387 cardiac arrests from the NSW registry (Jan 2017 - June 2021).
- Defined ECPR-eligible arrests based on case criteria and refractory status.
- Utilized transport accessibility modeling to simulate prehospital ECPR service coverage and timing.
Main Results:
- 488 OHCA patients were confirmed ECPR-eligible and refractory in Sydney.
- A hypothetical optimally located prehospital ECPR team could treat 437 (90%) patients within 60 minutes.
- Estimated survival with prehospital ECPR was 48%, potentially saving one life per 3.0 patients compared to conventional CPR.
Conclusions:
- A substantial number of OHCA patients could have benefited from prehospital ECPR.
- Prehospital ECPR offers a significant survival advantage over conventional CPR.
- Optimal ECPR service location and accessibility are crucial for maximizing patient survival.
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