Pre-hospital ECPR for refractory cardiac arrest - The PRECARE pilot feasibility study

Area of Science:

• Emergency Medicine
• Cardiovascular Research
• Critical Care

Background:

• Survival rates for refractory out-of-hospital cardiac arrest (OHCA) using conventional cardiopulmonary resuscitation (CCPR) are low.
• Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory OHCA, with outcomes depending on low-flow time.
• Pre-hospital ECPR aims to minimize low-flow time, potentially improving outcomes.

Purpose of the Study:

• To assess the feasibility of pre-hospital ECPR delivered by pre-hospital physicians.
• To evaluate the potential of pre-hospital ECPR to reduce low-flow times in OHCA patients.
• To determine the accessibility and sustainability of pre-hospital ECPR services.

Main Methods:

• A single-arm, open-label feasibility trial involving pre-hospital physicians delivering ECPR.
• Inclusion criteria: patients <70 years, witnessed collapse, initial shockable rhythm, within 45-minute radius of the mobile team.
• Patients were transported to ECMO-capable centers after extracorporeal support initiation.

Main Results:

• 12 out of 123 cardiac arrests (10%) received pre-hospital ECPR over 103 recruitment days.
• All patients were successfully cannulated on scene; mean low-flow time was 39 minutes.
• 33% of patients were liberated from VA ECMO, and 25% survived to discharge with intact neurological function (CPC 1-2).

Conclusions:

• Pre-hospital ECPR by trained medical teams is achievable and reduces OHCA low-flow times.
• This approach demonstrates potential for increased access and sustainability of ECPR.
• Larger studies are necessary to evaluate the efficacy and cost-effectiveness of pre-hospital ECPR.