Prehospital Extra-Corporeal Cardiopulmonary Resuscitation A Systematic Review of Patient Selection Criteria and Dispatch Protocols
Article Sidebar
Main Article Content
Abstract
Introduction
Out-of-hospital cardiac arrest remains a global health problem. There is emerging evidence that the use of extra-corporeal membrane oxygenation during resuscitation [ECPR], may help to improve outcomes. Several prehospital services around the world are now able to provide on-scene ECPR. However, the early identification of patients is a key factor in enabling this level of response to OOHCA. This systematic review aims to identify prehospital ECPR systems and describe their patient selection criteria and dispatch processes.
Methods
A systematic literature search of the MEDLINE and Embase databases was performed between the dates of 4th April 2024 and 11th April 2024. Study registries were also reviewed to identify the protocols of ongoing or planned studies. Additionally, forwards and backwards reference tracing of eligible literature was performed to identify further articles.
Results
A total of ten studies were identified. When combined, criteria involving premorbid conditions were the most frequently utilised, in eight out of ten included studies. Age-related, the requirement for a witnessed cardiac arrest, resuscitation-related factors and ECPR-related factors were all used in seven studies. The use of an aetiology or presenting rhythm related criteria were both reported in five studies. The dispatch processes for ECPR teams were varied and included both helicopter and ground-based services. ECPR was planned to be performed on scene in nine systems, and one described the use of a rendezvous strategy.
Conclusions
Variability in the selection criteria and dispatch processes used by the identified ECPR services is likely to be reflective of the variation in geographical distribution, team composition and transport modes of prehospital EPCR services. Many eligibility criteria can be determined during emergency call receipt or shortly after resource arrival, highlighting the potential for improved screening by emergency medical dispatchers and non-specialist resources.
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Publishing in IJOP allows authors to keep their copyright while giving IJOP unrestricted copyright permissions. Articles published in IJOP use Creative Common Attribution 4.0 International (CC BY-ND 4.0) licensing. This license requires that re-users give credit to the creator. It allows re-users to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes. Additional terms apply and can be accessed here.
Publishing in IJOP also allows authors to have contracts for non-exclusive distribution of the Journal's published version of the article, such as posting to an institutional repository or publication in a book, on the condition that the original publication in the original layout format in IJOP is retained and acknowledged.
We permit and encourage authors to post the articles they published in IJOP on their affiliated websites. This helps share the information, encourages citation in other works, and promotes scholarly discourse in the spirit of open access.
References
Abrams, D., MacLaren, G., Lorusso, R., Price, S., Yannopoulos, D., Vercaemst, L., ... & Brodie, D. (2022). Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Medicine, 48(1), 1-15. https://doi.org/10.1007/s00134-021-06514-y
Ali, S., Moors, X., van Schuppen, H., Mommers, L., Weelink, E., Meuwese, C. L., ... & Dos Reis Miranda, D. (2024). A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), 31. https://doi.org/10.1186/s13049-024-01198-x
Bartos, J. A., Frascone, R. J., Conterato, M., Wesley, K., Lick, C., Sipprell, K., ... & Yannopoulos, D. (2020). The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: program description, performance, and outcomes. EClinicalMedicine, 29. https://doi.org/10.1161/circ.142.suppl_4.365
Chahine, J., Kosmopoulos, M., Raveendran, G., Yannopoulos, D., & Bartos, J. A. (2023). Impact of age on survival for patients receiving ECPR for refractory out-of-hospital VT/VF cardiac arrest. Resuscitation, 193, 109998. https://doi.org/10.1016/j.resuscitation.2023.109998
Charlson, M. E., Carrozzino, D., Guidi, J., & Patierno, C. (2022). Charlson comorbidity index: a critical review of clinimetric properties. Psychotherapy and psychosomatics, 91(1), 8-35. https://doi.org/10.1159/000521288
Chin, Y. H., Yaow, C. Y. L., Teoh, S. E., Foo, M. Z. Q., Luo, N., Graves, N., ... & Ho, A. F. W. (2022). Long-term outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation, 171, 15-29. https://doi.org/10.1016/j.resuscitation.2021.12.026
De Charrière, A., Assouline, B., Scheen, M., Mentha, N., Banfi, C., Bendjelid, K. and Giraud, R., 2021. ECMO in cardiac arrest: a narrative review of the literature. Journal of Clinical Medicine, 10(3), p.534. https://doi.org/10.3390/jcm10030534
Downing, J., Al Falasi, R., Cardona, S., Fairchild, M., Lowie, B., Chan, C., ... & Tran, Q. K. (2022). How effective is extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest? A systematic review and meta-analysis. The American Journal of Emergency Medicine, 51, 127-138. https://doi.org/10.1016/j.ajem.2021.08.072
Fernando, S. M., McIsaac, D. I., Rochwerg, B., Cook, D. J., Bagshaw, S. M., Muscedere, J., ... & Kyeremanteng, K. (2020). Frailty and associated outcomes and resource utilization following in-hospital cardiac arrest. Resuscitation, 146, 138-144. https://doi.org/10.1016/j.resuscitation.2019.11.011
Gilhooley, C., Burnhill, G., Gardiner, D., Vyas, H., & Davies, P. (2019). Oxygen saturation and haemodynamic changes prior to circulatory arrest: implications for transplantation and resuscitation. Journal of the Intensive Care Society, 20(1), 27-33. https://doi.org/10.1177/1751143718764541
Gottula, A. L., Qi, M., Lane, B. H., Shaw, C. R., Gorder, K., Powell, E., ... & CARES Surveillance Group. (2024). Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model. Prehospital Emergency Care, 1-27. https://doi.org/10.1080/10903127.2024.2355652
Hutin, A., Ricard-Hibon, A., Briole, N., Dupin, A., Dagron, C., Raphalen, J. H., ... & Lamhaut, L. (2022). First description of a helicopter-borne ECPR team for remote refractory out-of-hospital cardiac arrest. Prehospital Emergency Care, 26(1), 89-92. https://doi.org/10.1080/10903127.2020.1859026
Inoue, A., Hifumi, T., Sakamoto, T., & Kuroda, Y. (2020). Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest in adult patients. Journal of the American Heart Association, 9(7), e015291. https://doi.org/10.1161/JAHA.119.015291
Kikuta, S., Inoue, A., Ishihara, S., Takahashi, R., Ijuin, S., Matsuyama, S., & Nakayama, S. (2023). Long-term outcomes and prognostic factors of extracorporeal cardiopulmonary resuscitation in patients older than 75 years: a single-centre retrospective study. Emergency Medicine Journal, 40(4), 264-270. https://doi.org/10.1136/emermed-2021-212138
Lamhaut, L., Hutin, A., Puymirat, E., Jouan, J., Raphalen, J. H., Jouffroy, R., ... & Carli, P. (2017). A pre-hospital extracorporeal cardio pulmonary resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: an observational study and propensity analysis. Resuscitation, 117, 109-117. https://doi.org/10.1016/j.resuscitation.2017.04.014
Lawler, P. R., Silver, D. A., Scirica, B. M., Couper, G. S., Weinhouse, G. L., & Camp Jr, P. C. (2015). Extracorporeal membrane oxygenation in adults with cardiogenic shock. Circulation, 131(7), 676-680. https://doi.org/10.1161/CIRCULATIONAHA.114.006647
Leivaditis, V., Papatriantafyllou, A., Khokhar, S., Haaf, B., Kammerer, I., Kinn, M., ... & Dahm, M. (2023). Successful Prehospital Extracorporeal Cardiopulmonary Resuscitation: A Comprehensive Case Report and Analysis of the Current Experience and Knowledge. Cureus, 15(12). doi: 10.7759/cureus.49975
Leung, K. B., Hartley, L., Moncur, L., Gillon, S., Short, S., Chan, T. C., & Clegg, G. R. (2024). Assessing Feasibility of Proposed Extracorporeal Cardiopulmonary Resuscitation Programmes for Out-of-Hospital Cardiac Arrest in Scotland via Geospatial Modelling. Resuscitation, 110256. https://doi.org/10.1016/j.resuscitation.2024.110256
Low, C. J. W., Ramanathan, K., Ling, R. R., Ho, M. J. C., Chen, Y., Lorusso, R., ... & Brodie, D. (2023). Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis. The Lancet Respiratory Medicine, 11(10), 883-893. https://doi.org/10.1016/S2213-2600(23)00137-6
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372. https://doi.org/10.1136/bmj.n71
Petermichl, W., Philipp, A., Hiller, K. A., Foltan, M., Floerchinger, B., Graf, B., & Lunz, D. (2021). Reliability of prognostic biomarkers after prehospital extracorporeal cardiopulmonary resuscitation with target temperature management. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29, 1-12. https://doi.org/10.1186/s13049-021-00961-8
Pozzi, M., Cesareo, E., Pinero, D., Dubien, P. Y., & Richard, J. C. (2022). Pre-hospital extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: preliminary results of a multidisciplinary approach. Resuscitation, 176, 19-20. DOI: 10.1016/j.resuscitation.2022.04.031
Resuscitation Council UK. (2024, January 11). New data reveals decrease in out-of-hospital cardiac arrest survival rates in England. https://www.resus.org.uk/about-us/news-and-events/new-data-reveals-decrease-out-hospital-cardiac-arrest-survival-rates
Richardson, S. A. C., Anderson, D., Burrell, A. J. C., Byrne, T., Coull, J., Diehl, A., ... & Bernard, S. (2023). Pre-hospital ECPR in an Australian metropolitan setting: a single-arm feasibility assessment—The CPR, pre-hospital ECPR and early reperfusion (CHEER3) study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1), 100. https://doi.org/10.1186/s13049-023-01163-0
Richardson, S., (2024) Pre-hospital ECMO or Conventional Resuscitation for Refractory Cardiac Arrest (PACER), ClinicalTrials.gov. Identifier NCT06177730. Available at: https://clinicaltrials.gov/study/NCT06177730
Sim, J. H., Kim, S. M., Kim, H. R., Kang, P. J., Kim, H. J., Lee, D., ... & Choi, I. C. (2024). Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis. Journal of Internal Medicine, 296(4), 350-361. https://doi.org/10.1111/joim.20002
Singer, B., Reynolds, J. C., Davies, G. E., Wrigley, F., Whitbread, M., Faulkner, M., ... & Finney, S. J. (2020). Sub30: Protocol for the Sub30 feasibility study of a pre-hospital Extracorporeal membrane oxygenation (ECMO) capable advanced resuscitation team at achieving blood flow within 30 min in patients with refractory out-of-hospital cardiac arrest. Resuscitation Plus, 4, 100029. https://doi.org/10.1016/j.resplu.2020.100029
Song, C., Dennis, M., Burns, B., Dyson, S., Forrest, P., Ramanan, M., ... & Moylan, E. (2022). Improving access to extracorporeal membrane oxygenation for out of hospital cardiac arrest: pre-hospital ECPR and alternate delivery strategies. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), 77. doi: 10.1186/s13049-022-01064-8
Stretch, B. and Singer, B., (2024). Out‐of‐hospital cardiac arrest: pathways for extracorporeal cardiopulmonary resuscitation in the United Kingdom. Anaesthesia, 79(9), 901-904. https://doi.org/10.1111/anae.16316
Ter Avest, E., Tunnicliff, M., Griggs, J., Griffiths, D., Cody, D., Nelson, M., ... & Lyon, R. M. (2022). In-hospital extracorporeal cardiopulmonary resuscitation for patients with an out-of-hospital cardiac arrest in a semi-rural setting: An observational study on the implementation of a helicopter emergency medical services pathway. Resuscitation plus, 12, 100339. https://doi.org/10.1016/j.resplu.2022.100339
Tran, A., Rochwerg, B., Fan, E., Belohlavek, J., Suverein, M. M., van de Poll, M. C., ... & Fernando, S. M. (2023). Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation, 110004. https://doi.org/10.1016/j.resuscitation.2023.110004
Wissenberg, M., Folke, F., Hansen, C. M., Lippert, F. K., Kragholm, K., Risgaard, B., ... & Torp-Pedersen, C. (2015). Survival after out-of-hospital cardiac arrest in relation to age and early identification of patients with minimal chance of long-term survival. Circulation, 131(18), 1536-1545. https://doi.org/10.1161/CIRCULATIONAHA.114.013122