Abstract 380: Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model

Abstract

Introduction: Evidence suggests that ECPR can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, over 50% of potential ECPR candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the U.S. in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR HEMS-based system (Figure 1). Methods: We constructed a GIS model to estimate ground and helicopter transport times. Time-dependent rates of ECPR eligibility were derived from the Resuscitation Outcome Consortium (ROC) database, while the Cardiac Arrest Registry to Enhance Survival (CARES) registry determined the number of OHCA patients meeting ECPR criteria within designated transportation times. EMS response time, ECPR candidacy determination time, and on-scene time were modeled based on data from the EROCA trial (Figure 1). The combined model was used to estimate the total ECPR candidates in each system. Results: The CARES registry recorded 736,066 OHCA patients from 2013 to 2021. After applying clinical eligibility criteria, 24,661 (3.4%) patients were eligible for ECPR. When considering overall ECPR eligibility within 45 minutes from OHCA to initiation, only 11.76% of clinically eligible patients qualified in the current hospital-based system. The prehospital ECPR HEMS-based system exhibited a four-fold increase in ECPR eligibility (49.3%), while the prehospital ground-based system showed a more than two-fold increase (28.4%). Conclusions: The study demonstrates a two-fold increase in ECPR eligibility for a field-deployable ground-based system and a four-fold increase for a prehospital ECPR HEMS-based system compared to the current hospital-based OHCA system. This novel GIS model can inform future ECPR implementation strategies, optimizing systems of care.