Figure 2: University of Utah results using ED ECMO alerts for OHCA
rate of 22%, including 13% with good
3 although defining a matching comparison group of
patients who underwent continued
resuscitation by conventional methods
is likely to be biased due to the nonran-domized nature of the comparison. An
estimate of 9% survival for comparable
non-ECPR patients has been given in
A pilot study in Australia reported on
26 patients ( 11 of whom experienced
OHCA) treated with ECPR, mechanical
CPR and intra-arrest therapeutic hypothermia, with a 54% survival to hospital
discharge with full neurologic recovery.
There are several ongoing studies in
the United States and around the world,
including a recent publication from the
University of Minnesota, which show
promising results. In the study, three
EMS agencies routed 18 refractory
v fib/v tach arrest patients over a three-month period with 83% of the patients
being placed on ECMO. Remarkably,
50% survived to hospital discharge with
good neurological function.
Although ECPR seems promising, a
critical factor for successful outcomes
continues to be early, effective CPR, early selection of qualified cases and rapid placement on
At the University of Utah Medical Center in
Salt Lake City, an interdisciplinary team of pre-hospital providers from the Salt Lake City Fire
Department, emergency physicians, critical care
specialists, cardiologists and cardiothoracic surgeons developed an ECPR treatment pathway for
select OHCA victims that started in April 2015.
Patients are identified by prehospital providers
and the ED is alerted to a potential ECPR candidate prior to arrival. Mechanical CPR devices
are used to limit interruptions in blood flow during transport.
On arrival, high-quality mechanical CPR is continued in the ED while the patient is prepped for
cannulation using sterile technique. Ultrasound
guidance is used as two 6-French angiocatheters
are inserted into a femoral artery and femoral vein.
Table 2: University of Utah ECLS criteria