Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model

Adam L Gottula; Man Qi; Bennett H Lane; Christopher R Shaw; Kari Gorder; Elizabeth Powell; Kyle Danielson; Anna Ciullo; Nicholas J Johnson; Joseph E Tonna; William R Hinckley; Amy Koshoffer; Rabab Al-Araji; Jason Bartos; Justin Benoit; Cindy H Hsu; CARES Surveillance Group

doi:10.1080/10903127.2024.2355652

Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model

Prehosp Emerg Care. 2024 May 13:1-27. doi: 10.1080/10903127.2024.2355652. Online ahead of print.

Authors

Adam L Gottula^{1

2

3}, Man Qi⁴, Bennett H Lane⁵, Christopher R Shaw⁶, Kari Gorder⁷, Elizabeth Powell⁸, Kyle Danielson⁹, Anna Ciullo¹⁰, Nicholas J Johnson¹¹, Joseph E Tonna¹⁰, William R Hinckley^{5

12}, Amy Koshoffer¹³, Rabab Al-Araji¹⁴, Jason Bartos¹⁵, Justin Benoit⁵, Cindy H Hsu^{1

3

16}; CARES Surveillance Group

Affiliations

¹ Department of Emergency Medicine, University of Michigan.
² Department of Anesthesiology, University of Michigan.
³ Max Harry Weil Institute for Critical Care Research and Innovation.
⁴ Department of Geography and Geographic Information System, The University of Cincinnati.
⁵ Department of Emergency Medicine, University of Cincinnati.
⁶ Department of Emergency Medicine, Division of Critical Care, Oregon Health and Science University.
⁷ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital.
⁸ Department of Emergency Medicine, The University of Maryland.
⁹ AirLift Northwest, University of Washington.
¹⁰ Department of Emergency Medicine, University of Utah.
¹¹ Department of Emergency Medicine & Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington.
¹² UC Health, Air Care and Mobile Care.
¹³ University of Cincinnati Libraries, The University of Cincinnati.
¹⁴ The Cardiac Arrest Registry to Enhance Survival.
¹⁵ Center for Resuscitation Medicine, The University of Minnesota.
¹⁶ Department of Surgery, University of Michigan.

PMID: 38739864
DOI: 10.1080/10903127.2024.2355652

Abstract

Introduction: Evidence suggests that Extracorporeal Cardiopulmonary Resuscitation (ECPR) can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, when ECPR is indicated over 50% of potential candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the United States in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR Helicopter Emergency Medical Services (HEMS)-based system.

Methods: We constructed a GIS model to estimate ground and helicopter transport times. Time-dependent rates of ECPR eligibility were derived from the Resuscitation Outcome Consortium (ROC) database, while the Cardiac Arrest Registry to Enhance Survival (CARES) registry determined the number of OHCA patients meeting ECPR criteria within designated transportation times. Emergency Medical Services (EMS) response time, ECPR candidacy determination time, and on-scene time were modeled based on data from the EROCA trial. The combined model was used to estimate the total ECPR eligibility in each system.

Results: The CARES registry recorded 736,066 OHCA patients from 2013 to 2021. After applying clinical criteria, 24,661 (3.4%) ECPR-indicated OHCA were identified. When considering overall ECPR eligibility within 45 minutes from OHCA to initiation, only 11.76% of OHCA where ECPR was indicated were eligible in the current hospital-based system. The prehospital ECPR HEMS-based system exhibited a four-fold increase in ECPR eligibility (49.3%), while the prehospital ground-based system showed a more than two-fold increase (28.4%).

Conclusions: The study demonstrates a two-fold increase in ECPR eligibility for a field-deployable ground-based system and a four-fold increase for a prehospital ECPR HEMS-based system compared to the current hospital-based OHCA system. This novel GIS model can inform future ECPR implementation strategies, optimizing systems of care.

Keywords: Geographic Information Systems; cardiopulmonary resuscitation; emergency medical services; extracorporeal cardiopulmonary resuscitation; extracorporeal membrane oxygenation; out-of-hospital cardiac arrest.