The FaciLItated hospital-based ECPR via Helicopter Transport (FLIGHT-to-ECPR) study

Area of Science:

• Emergency Medicine
• Cardiovascular Research
• Transport Medicine

Background:

• Out-of-hospital cardiac arrest (OHCA) survival is poor, especially for refractory ventricular fibrillation/ventricular tachycardia (VF/VT).
• Extracorporeal cardiopulmonary resuscitation (ECPR) improves outcomes but is limited by geographic access in rural areas due to extended low-flow times.

Purpose of the Study:

• To test the hypothesis that a Helicopter-EMS (HEMS)-facilitated, hospital-based ECPR pathway can increase rural access.
• To determine if this pathway preserves clinical outcomes comparable to standard ground-transport ECPR.

Main Methods:

• Prospective observational cohort study (FLIGHT-to-ECPR) of adults (18-75 years) with refractory VF/VT OHCA.
• Parallel EMS and HEMS activation with intra-arrest mechanical-CPR transport to an ECMO center.
• 1:1 matched comparison with standard ground-transport ECPR cohort, matched on low-flow time; primary outcome: survival to discharge with favorable neurologic status (CPC 1-2).

Main Results:

• 45 patients underwent FLIGHT activation; 27 received ECPR. Mean low-flow time was 85.9±29.3 minutes.
• Overall favorable neurologic survival was 33.3% (15/45).
• Matched ECPR patients (n=27/group) showed identical favorable neurologic survival (25.9%) and similar low-flow times (85.9±29.3 vs. 87.1±29.2 min; p > 0.99).

Conclusions:

• HEMS-facilitated ECPR is feasible and expands rural access to advanced resuscitation.
• This strategy safely preserves neurologic outcomes comparable to standard ground-transport ECPR.
• Optimized systems can overcome geographic barriers to ECPR, maintaining timely reperfusion.