Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest

Chonde, Meshe; Escajeda, Jeremiah; Elmer, Jonathan; Callaway, Clifton W.; Guyette, Francis X.; Boujoukos, Arthur J.; Sappington, Penny L.; Smith, A.J. Conrad; Schmidhofer, Mark; Sciortino, Christopher M.; Kormos, Robert L.

doi:10.1016/j.resuscitation.2019.12.015

Cited by 21 publications

(8 citation statements)

References 34 publications

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“…When EMTs rapidly arrive on the scene for pre-hospital emergency care, the process of transport to the hospital can be viewed as a race of physical fitness against time. The study of Chonde et al (2020) showed that the median time from arrival to departure of ambulance personnel was 20 min (interquartile range (IQR) 19-20 min), and the time to the hospital was 34 min (IQR 30-45 min), so the duration of pre-hospital CPR was 26 min (IQR 25-40 min) 32 . One of the main challenges in transporting OHCA patients to the hospital is the maintenance of high-quality CPR during the transport process, especially in difficult transport conditions 33 .…”

Section: Discussionmentioning

confidence: 99%

“…It is not difficult to understand that whether OHCA patients receive chest compressions is the focus of the entire CPR process. Since the emergency treatment time (pre-hospital time) after the EMT comes into contact with the patient may be affected by long distances or peak traffic times, or even difficult situations, the time of performing CPR may be extended to dozens of minutes 32 , 38 . In these dozens of minutes of on-site processing and transportation time, it is critical to perform and maintain high-quality CPR (with ideal compression quality, shortest “hand-off” time, and the best conditions for intervention) to achieve ROSC.…”

Section: Discussionmentioning

confidence: 99%

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The feasibility of emergency medical technicians performing intermittent high-quality cardiopulmonary resuscitation

Chang¹,

Hsu²,

Li³

et al. 2021

Int. J. Med. Sci.

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Background: Whether intermittent chest compressions have an effect on the quality of CPR is worthy of discussion. The purpose of this study was to investigate differences in the chest compression quality of emergency medical technicians (EMTs) performing cardiopulmonary resuscitation (CPR) with different rest intervals. Methods: Seventy male firefighters with EMT licenses participated in this study. Participants completed body composition measurements and three CPR quality tests, as follows: (1) CPR-uninterrupted for 10 minutes; (2) after 2 days of rest, CPR 10s-intermittent (CPR-10s), for 2 minutes each time and 5 cycles; (3) after another 2 days of rest, CPR 20s-intermittent (CPR-20s), for 2 minutes each time and 5 cycles. Results: Body composition results showed that body mass (BM), body mass index (BMI), upper limb muscle mass (ULMM), core muscle mass (CMM), and upper limb-core muscle mass (UL+CMM) were positively correlated with chest compression depth (CCD) ( p < 0.05). Analysis of the three different modes of CPR quality analysis indicated significant differences in the chest compression fraction (CCF, F = 6.801, p = 0.001), chest compression rebound rate (CCRR, F = 3.919, p = 0.021), and ratings of perceived exertion (RPE, F = 23.815, p < 0.001). Among the different performance cycles of CPR-10s, significant differences were found in CCF, CCD, CCR (chest compression rate), and RPE ( p < 0.05). On the other hand, among the different performance cycles of CPR-20s, significant differences were found in CCD, CCR, and RPE ( p < 0.05). Moreover, the CCF, CCD, and RPE scores of the two tests reached significant differences in specific phases ( p < 0.05). Conclusions: This study confirmed that the upper limb muscle mass or the weight of the upper body of EMTs is positively correlated with the quality of CPR. In addition, intermittent chest compressions with safe interruption intervals can reduce fatigue caused by long-term chest compressions and maintain better chest compression quality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The feasibility of emergency medical technicians performing intermittent high-quality cardiopulmonary resuscitation

Chang¹,

Hsu²,

Li³

et al. 2021

Int. J. Med. Sci.

View full text Add to dashboard Cite

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“…20 Several clinical investigators also claimed the need for ECPR programs in medium urban population centers. 21,22 However, such programs are recommended to be implemented by institutions with high-volume experience in the comprehensive management of ECMO therapy for advanced cardiac failure and potential demand for coronary interventions, long-term mechanical support, or heart transplantation. 23 Especially under ongoing CPR, a rapid decision-making process with predetermined criteria is crucial.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: first results and outcomes of a newly established ECPR program in a large population area

et al. 2021

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Objectives: Out-of-hospital cardiac arrest (OHCA) is associated with excessively high mortality rates. Recent studies suggest benefits from extracorporeal cardiopulmonary resuscitation (ECPR) performed in selected patients. We sought to present the first results from our interdisciplinary ECPR program with a particular focus on early outcomes and potential risk factors associated with in-hospital mortality. Methods: Between January 2016 and December 2019, 44 patients who underwent ECPR selected according to our institutional ECPR protocol were retrospectively analyzed regarding pre-hospital, in-hospital, and early outcome parameters. Patients were divided into survivors (S) and non-survivors (NS). Statistical analysis of risk factors regarding in-hospital mortality of the patient cohort analyzed was performed. Results: The mean age of the population was 53 ± 12 years, with most patients being male ( n = 40). The leading cause of cardiac arrest (CA) was myocardial infarction ( n = 24, 55%). The median hospital stay was 1 (1;13) day. Twenty-three percent of patients ( n = 10) were discharged from hospital including eight patients (18%) with CPC 1–2. Survivors showed a trend toward shorter pre-hospital CPR duration (60 (59;60) min (S) vs 60 (55;90) min (NS), p = 0.07). Conclusion: Establishing ECPR programs in large population areas offers the option to improve survival rates for OHCA patients. Stringent compliance of institutional criteria (mainly age, witnessed arrest, and time of pre-hospital resuscitation) and providing ECPR to strictly selected patients seems to be a vital factor for such programs’ success. Pre-clinical settings and therapeutic measures must be adjusted in this regard to improve outcomes for this highly demanding patient cohort.

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“…Use of an ultrasound guided robotic system to obtain vascular access and place these catheters will enable these procedures to be performed in areas without highly skilled providers and improve timely access to life saving interventions. In both REBOA and ECMO, the rate limiting step is safe cannulization of the femoral artery [9]. This task is typically performed by one or two physicians in the controlled environment of a resuscitation bay or operating room [4].…”

Section: Background a Vascular Accessmentioning

confidence: 99%

Toward Robotically Automated Femoral Vascular Access

Zevallos

Harber

Abhimanyu

et al. 2021

2021 International Symposium on Medical Robotics (ISMR)

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Advanced resuscitative technologies, such as Extra Corporeal Membrane Oxygenation (ECMO) cannulation or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), are technically difficult even for skilled medical personnel. This paper describes the core technologies that comprise a teleoperated system capable of granting femoral vascular access, which is an important step in both of these procedures and a major roadblock in their wider use in the field. These technologies include a kinematic manipulator, various sensing modalities, and a user interface. In addition, we evaluate our system on a surgical phantom as well as invivo porcine experiments. These resulted in, to the best of our knowledge, the first robot-assisted arterial catheterizations; a major step towards our eventual goal of automatic catheter insertion through the Seldinger technique.

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Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest

Cited by 21 publications

References 34 publications

The feasibility of emergency medical technicians performing intermittent high-quality cardiopulmonary resuscitation

The feasibility of emergency medical technicians performing intermittent high-quality cardiopulmonary resuscitation

Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: first results and outcomes of a newly established ECPR program in a large population area

Toward Robotically Automated Femoral Vascular Access

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