This document discusses expanding the use of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest patients. It examines current guidelines on patient selection criteria and outlines a proposed collaborative model for pre-hospital ECPR delivery. This model involves advanced paramedics performing roadside cannulation to begin ECPR within 10 minutes of arrest. It also discusses developing common training standards, clinical governance structures, and telemedicine support to safely implement a pre-hospital ECPR system across multiple centers. The goal is to establish earlier ECPR access for select cardiac arrest patients.
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ECPR at the Roadside - Mamoun Abu-Habsa - TBS24
1. 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
12. - 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
14. 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
17. 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
18. 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
20. 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
26. 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
27. 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
29. 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
30. 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?