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KnowEMS | "Know EMS on ECMO-CPR" Webinar highlights

By project KnowEMS staffPublished on

The "Know EMS on ECMO-CPR" webinar provided valuable insights into the use of Extracorporeal Cardiopulmonary Resuscitation (ECPR) in emergency medical services. The event featured speakers from France, Israel, and Spain, who shared their experiences and best practices.

The 2023 AHA guidelines update emphasized the use of ECPR for patients with cardiac arrest refractory to standard ACLS, highlighting its reasonableness in select patients when provided by a trained and equipped system of care.

Speakers:

  • Dr. Alice Hutin, MD, PhD (France): Discussed ECMO in the French pre-hospital setting.
  • Tomer Kaplan (Israel): Shared experiences with E-CPR in the field.
  • Sandra Rosillo (Spain): Provided insights on teamwork between pre-hospital and in-hospital staff to improve E-CPR outcomes.

Main Issues Observed:

  • French Pre-Hospital Setting (Dr. Alice Hutin):
    • Early recognition of cardiac arrest and immediate call to SAMU are crucial.
    • Optimizing the chain of survival through bystander CPR, basic life support, and advanced life support.
    • Eligibility criteria for ECPR include non-traumatic cardiac arrest, no major comorbidities, no flow < 5 minutes, refractory VF, and signs of life during CPR.
    • The goal is to cannulate the patient to ECMO within 60 minutes of cardiac arrest onset.
    • A dedicated vehicle with a multidisciplinary team is used for cannulation under sterile conditions.
    • Key messages: anticipate system of care, optimal chain of survival, select patients and timing, provide multidisciplinary care, and ensure training and simulation.
  • MDA Israel Experience (Tomer Kaplan):
    • Survival rates for pre-hospital CPR range from 2% to 9%, with ROSC rates at 29.7%.
    • A recent survey (2018-2021) showed a 7.5% overall survival rate with CPC 4%.
    • Strategies to improve outcomes include a digital OHCA registry, training for dispatch BLS-ACLS, AED coverage, dispatcher tools, and implementation of new techniques like double defibrillation.
    • E-CPR results: 21 events, 15 cannulation attempts, 11 successful, 6 survived at 30 days, 4 with CPC 1-2.
    • Emphasized the importance of good communication and a human approach.
  • La Paz Organization (Sandra Rosillo):
    • E-CPR is not suitable for everyone; intense training is required to decrease no-flow duration and improve cannulation success.
    • A multidisciplinary team selects strict criteria for patient eligibility.
    • The process is ongoing and requires more cases to draw definitive conclusions.

The webinar underscored the importance of a well-coordinated system of care, proper training, and effective communication to enhance ECPR outcomes in EMS settings.

The webinar recording is available here: https://youtu.be/X8dpYsPQqgA?si=SEYe6sK9hkLfeBLp