Abstract 115: Extracorporeal Cardiopulmonary Resuscitation for Refractory Out of Hospital Cardiac Arrest (EROCA) - Results of a Randomized Feasibility Trial of Expedited Prehospital Transport

Abstract

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is promising but is unproven, and outcomes are strongly dependent on time to initiation of therapy. Expedited transport may facilitate opportunities for ECPR in clinical practice and future trials. Hypotheses: We hypothesized that a real-time dispatch-based computer algorithm could select refractory OHCA patients who could be reliably transported to the emergency department (ED) within 30 min of the 911 call, and that Emergency Medicine physicians could initiate ECPR in eligible patients within 30 min of ED arrival. Methods: In a 2-tiered EMS system serving a US city of 100k in 29 square miles with an ECPR capable primary destination hospital, adults with refractory shockable or witnessed OHCA were randomized 4:1 to expedited transport (ET) or standard prehospital care (SC) if the predicted 911 to ED arrival time was <30 min. A maximum sample size of 24 was planned. The study required exception from informed consent. The primary outcomes were the proportion of patients with 911 to ED arrival <30 min and ED arrival to ECPR flow <30 min. Results: Out of 156 cardiac arrest runs, 15 participants (10%) were randomized prior to ending the trial for slow accrual. Five of 12 patients randomized to expedited transport had an ED arrival time of <30 min (mean 32.5+7.1). All ECPR eligible patients were cannulated, 3 of 5 receiving ECPR had flow initiated <30 min of ED arrival (mean 32.4+10.9), and 7 were ECPR ineligible. One patient (randomized to SC) survived to 30 days, and no patients in either group survived with a good neurological outcome. Conclusions: EROCA demonstrated a functional model for selecting patients with refractory OHCA for ET in an ECPR capable system but did not meet predefined time-interval targets. These results provide important insight into the feasibility of ECPR clinical trials and clinical practice based on selected target intervals.