(1403) Activation and Cannulation Outcomes of a New Extracorporeal Cardiopulmonary Resuscitation Program

Introduction: Extracorporeal Cardiopulmonary Resuscitation (ECPR) is a process of care within the chain of survival following out of hospital cardiac arrest (OHCA). Multiple randomized controlled trials have demonstrated the feasibility of ECPR. This has led to the expansion of ECPR in local systems, and we describe the incidence of ECPR activations, cannulations and outcomes following two years of the ECPR program at University Hospitals Cleveland Medical Center

Methods: This is a description of the ECPR program at University Hospitals Cleveland Medical Center (UHCMC). Patients who suffer OHCA of a presumed cardiac cause within our catchment area are activated as an ECPR alert if they had a witnessed arrest, underwent bystander CPR, had an initial shockable rhythm and were transported with mechanical CPR ongoing to UHCMC within 30 minutes of arrest. Exclusion criteria include age over 65 and frailty as defined by nursing home residence. Once in the UHCMC Emergency Department (ED), patients undergo a biochemical screen that excludes patients if they have two of the following: pH < 7.00, lactic acid >15 and End Tidal CO2 < 10. If satisfied, patients are then cannulated for veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Clinical data is entered into a RedCap database and reviewed for programmatic improvement.

Results: There were 24 ECPR activations over 21 months. 19% of activations led to ECPR cannulation (4/21). 14% of activations achieved ROSC prior to cannulation (3/21). Those who didn't achieve ROSC or undergo cannulation died in the ED (66%, 14/21). Of the 4 cannulated, 2 were for refractory OHCA and 2 were for hypothermic arrest. The most common reason for activation to not move on to cannulation was failure to meet biochemical inclusion criteria (38%, 8/21). Mean duration of ECMO support was 3.3 days, and median hospital length of stay was 14 days. 3 of the cannulated patients (75%) survived to hospital discharge with good neurological function.

Conclusions: Our ED-based ECPR program is feasible and led to positive patient outcomes. This is a resource intensive process that has led to many more activations of the ECPR team than cannulations. The main reason for an ECPR activation to not lead to cannulation was failure to meet biochemical inclusion criteria.