Determining Access for a City-Wide Extracorporeal Cardiopulmonary Resuscitation (ECPR) Initiative Using Geospatial...

Area of Science:

• Emergency Medicine
• Cardiovascular Research
• Geospatial Analysis

Background:

• Out-of-hospital cardiac arrest (OHCA) patients may benefit from extracorporeal cardiopulmonary resuscitation (ECPR).
• ECPR eligibility often requires arrival at a capable center within 30 minutes of arrest.
• Geographic and logistical factors can limit access to time-sensitive ECPR interventions.

Purpose of the Study:

• To assess ECPR accessibility in Boston using geospatial modeling.
• To evaluate the impact of prehospital times on ECPR access.
• To determine necessary adjustments to ECPR criteria for broader geographic coverage.

Main Methods:

• Geospatial modeling calculated drive times to ECPR centers from census block groups in Boston.
• Simulated dispatch-to-scene times (7.4 min) and varying EMS on-scene times (10th, 25th, 50th percentiles) were used.
• Analysis considered high- and low-traffic conditions to determine access within a 30-minute arrest-to-arrival window.

Main Results:

• Under current median times, the entire City of Boston was excluded from ECPR access.
• Reducing on-scene time to the 10th percentile (13 min) allowed access for 55% of areas in low traffic and 28% in high traffic.
• Achieving 90% city-wide access under high traffic required extending the arrest-to-arrival criterion to 55.8 minutes.

Conclusions:

• The standard 30-minute arrest-to-arrival criterion for ECPR is not feasible for most of Boston with current prehospital times.
• Decreasing prehospital duration, particularly time on scene, is crucial for improving ECPR accessibility.
• Future strategies should explore novel delivery models, air transport, and potentially liberalized time criteria to enhance ECPR access.