“Hang on, there’s ECMO at my ALS!” Pre-hospital ECLS – now and into the future

Mr Benjamin Stanton1 

1Medstar

Abstract:

Out of hospital cardiac arrest (OOHCA) remains a leading cause of mortality and morbidity worldwide. Extracorporeal Cardiopulmonary Life Support (ECLS) is the application of extracorporeal membrane oxygenation (ECMO) during cardiac arrest to augment traditional advanced life support (ALS). It has been shown in the literature to have mixed success with survival rates varying between 15 – 60%. Issues such as appropriate patient selection criteria, timing to initiation of ECLS therapy and cost effectiveness continue to generate debate.

Pre-hospital ECLS initiation has been shown to be feasible, safe and effective, however it is yet to show a survival advantage to ECLS performed in the hospital setting. The advantages it has shown so far is the potential to generate a shorter period of ‘low flow’ circulatory state and subsequent increased rates of return of spontaneous circulation (ROSC).

This presentation will discuss a retrospective data review of patients who fulfilled specific ECLS criteria from a 2014 OOHCA demographic data set. In addition it will look at the potential role of a pre-hospital ECLS program in Adelaide, South Australia (SA) in conjunction with the South Australian Ambulance Service (SAAS) MedSTAR (SA Retrieval Service) and the two-tertiary referral ECMO centres. Also covered will be how important cannulation and device operation skills are and can be taught/maintained using a purpose built simulation trainer.

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