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

E Ter Avest; M Tunnicliff; J Griggs; D Griffiths; D Cody; M Nelson; T Hurst; R M Lyon

doi:10.1016/j.resplu.2022.100339

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

Resusc Plus. 2022 Dec 10:12:100339. doi: 10.1016/j.resplu.2022.100339. eCollection 2022 Dec.

Authors

E Ter Avest^{1

2}, M Tunnicliff^{1

3}, J Griggs¹, D Griffiths¹, D Cody⁴, M Nelson^{1

4}, T Hurst^{5

6}, R M Lyon^{1

7}

Affiliations

¹ Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK.
² Department of Emergency Medicine, University Hospital Groningen, the Netherlands.
³ Kings College NHS Trust, Department of Emergency Medicine, UK.
⁴ South East Coast Ambulance Service, UK.
⁵ Kings College NHS Trust, Department of Intensive Care Medicine, UK.
⁶ London's Airambulance, UK.
⁷ School of Health Sciences, University of Surrey, UK.

Abstract

Aim: In this study, we aimed to investigate the efficacy of a helicopter emergency medical service (HEMS) facilitated pathway for in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) for patients with an out of hospital cardiac arrest (OHCA) in a semi-rural setting.

Methods: We retrospectively reviewed all patients with an OHCA attended by a UK HEMS service between 1 January 2018 and 20 September 2021, when a dedicated ECPR pathway was in effect to facilitate transport of eligible patients to the nearest ECLS centre. The primary endpoint was the number of patients meeting ECPR eligibility criteria at three pre-defined time points: at HEMS dispatch, during on-scene evaluation and upon arrival in hospital.

Results: During the study period, 162 patients attended met ECPR pathway dispatch criteria. After on-scene evaluation, 74 patients (45%) had a return of spontaneously circulation before arrival of HEMS, 60 (37%) did not meet eligibility criteria regarding initial rhythm or etiology of the OHCA, and 15 (9%) had deteriorated (mainly into asystole) and were no longer suitable candidates upon arrival of HEMS. Eleven patients were eligible for ECPR and transported to hospital in arrest, and a further two patients were transported for post-ROSC ECLS. Nine patients deteriorated during transport and were no longer suitable ECPR candidates upon arrival. ECLS was successfully initiated in two patients (one intra-arrest, and one post-ROSC).

Conclusion: In-hospital ECPR is of limited value for patients with refractory OHCA in a semi-rural setting, even when a dedicated pathway is in place. Potentially eligible patients often cannot be transported within an appropriate timeframe and/or deteriorate before arrival in hospital.

Keywords: AED, Automatic External Defibrilator; CCP, Critical Care Paramedic; ECPR, extracorporeal cardiopulmonary resuscitation; Extracorporeal cardiopulmonary resuscitation (ECPR); HEMS, Helicopter emergency medical service; Helicopter emergency medical service (HEMS); KSS, Air Ambulance Charity Kent, Surrey and Sussex; OHCA, Out of hospital cardiac arrest.