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ECPR at the Roadside?
Dr Mamoun Abu-Habsa
MRCS(Ed) Dip IMC PGCE FRCEM FFICM
Consultant in Critical Care & Trauma
Regional Clinical Director for Adult Critical Care Retrieval
Barts Health NHS Trust, UK
The Big Sick Conference, Zermatt 2024
Novel Technique? 1976
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
Veno-Venous (VV) ECMO
Supporting lungs
e.g. ARDS patients
Veno-Arterial (VA) ECMO
Supporting the heart
e.g. Heart failure patient
ECMO, ECLS, ECPR, VA, VV . . . .
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
E-CPR: Who
are the
survivors?
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
ELSO New
Guidance
March 2021
Recommended Inclusion Criteria
- Well designed
- Standard protocol
- High quality CPR
- Consistent practice
- Single centre
- Variation in protocol / practice
- Limited or no experience in
some centres
- Larger study
- Multi-centre
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
 999
 Bystander
CPR/AED
Recognition BLS / ALS
EMS
 Packaging
 Loading
 Disembark
ing
Transport Handover
ER / Cath
Lab / OR
Why at the roadside?
5 mins 10-30 mins 5-40 mins 30-75 mins
Pre-Hospital ECMO in Patients with Refractory Cardiac Arrest
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
Pre-Hospital ECMO in Patients with Refractory Cardiac Arrest
Selection
Dispatch
Arrival
Femoral
Access
Cannulation ECPR
Advanced
Paramedics
7-30 mins
2019 July 2023
5 patients
< 5 mins < 10 mins 32-60 mins
ECMO
Consultants
ECMO
Consultants
Pre-Hospital ECMO in Patients with Refractory Cardiac Arrest
October 2019 July 2023
5 patients
32 mins  60 mins 2/5 Survived at 6/12 2/5 Survived at 6/12
Procedure Time: 8-15 mins Failure Rate: 0
ECPR Complications: 0
1 2 3 4 5
Set criteria
Set safety-nets
Re-invent
the wheel
01
02
03
04
Define shared
objective
05
Implement
and govern
Process Review
Earlier access to
ECLS
Age
No flow / Low flow
Contraindications
Team
Process
Equipment
Training
Governance
Needle
8F sheath
Wire
Dilate
Cannulate
Collaborative Delivery Model
Collaborative Delivery Model
Benchmarking
Benchmark
Circuits
Background
Cannulas
Configuration
Patient Management
Emergencies
Complications
Evidence
Transport
Curriculum
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
TRAINING PROGRAM
STEP 1 STEP 2 STEP 3
E-LEARNING ITERATIVE SYSTEM DESIGN PRE-HOSPITAL APPLICATION
CORE SKILLS TRAINING COLLECTIVE SKILLS TRAINING SUPERVISION
BEDSIDE TRAINING TROUBLESHOOTING MENTORSHIP
ASSESSMENT SKILL REVALIDATION INDEPENDENT PRACTICE
Individual
 CPD
 Reflection led
 Competence / credentialing
Team
 Collective performance
 Individual performance
 All case review KPI
Centre / Unit / Site
 Longitudinal audit
 Horizontal audit
 Inter-site and intra site metrics
System
 Robust
 Multi-layer
 Continual learning mechanisms
Clinical Governance
CPD
Feedback
Audit
Reflections
Safety
Responsiveness
Audit / SOPs
Safety
Effectiveness
Efficiency
CQC Matrices
Safety
Effectiveness
Efficiency
CQC Matrices
Clinical
Governance
Clinical Guidelines
Training Information
Systems
Equipment
Logistics
Standard Operating
Procedures
Standardised
Equipment
Remote Support
Capability
ECLS Capability Development
Common Training
Package
E-learning
Task Based
Collective
Macro-simulation
 999
 Bystander
CPR/AED
Recognition
BLS + ALS
3-4 Shocks
EMS
 Packaging
 Loading
 Auto-CPR
Transport ECLS
ER / Cath
Lab / OR
Is a System Approach Feasible?
5 mins 10 mins 5-15 mins < 30-45 mins
5 centres
Summary
The question is no longer of do we perform ECPR
for cardiac arrest? but rather, who do we
perform it on? and how do we safely, equitably
and efficiently deliver this service?
Questions?
: drmamoun01

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ECPR at the Roadside - Mamoun Abu-Habsa - TBS24