A study recently published in the journal Resuscitation shows that the use of extracorporeal cardio-pulmonary resuscitation (ECPR) in a pre-hospital setting significantly improves survival rates in out-of-hospital refractory heart attack victims. Such victims are those who show no signs of renewed circulation after 30 minutes of traditional resuscitation attempts.
ECPR involves inserting femoral vein and artery cannulae in the patient’s groin area. These are connected to a machine which circulates the blood and ensures the necessary gas exchange, replacing both heart and lung functions. Such systems are commonly used during open-heart surgery.
Mobile emergency medical service teams in Paris, the SAMU, initiated the study in 2011. Between November 2011 and December 2014, 114 patients were treated using ECPR either before or after arrival at the hospital. During the second phase, covering 2015, 42 victims were first treated by a dedicated mobile ECPR team. Patient screening limited study participants to those under 70 years of age whose attack had been witnessed and on whom traditional resuscitation attempts had been begun immediately. Other criteria covering the patient’s medical history, type of heart attack and the victim’s chances of neurological recovery were also applied.
This second, more aggressive strategy showed benefits when used on victims within 60 minutes of the initial attack. Today, survival rates among French patients suffering from a refractory heart attack are less than 5%. Pre-hospital ECPR reduced the period of low blood flow in victims by 20 minutes. When strict patient selection was added to aggressive, pre-hospital ECPR intervention, the survival rate climbed to 38%. The researchers concluded that using “ECPR in specific settings in the management of refractory OHCA is feasible and can lead to a significant increase in neurological intact survivors.” However, they cautioned that their data must be confirmed by a large-scale random controlled trial.