The Minnesota Mobile Extracorporeal Cardiopulmonary Resuscitation Consortium for Treatment of Out-of-Hospital Refractory Ventricular Fibrillation: Program Description, Performance, and Outcomes

Abstract

Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital (OH) cardiac arrest (CA). Methods: This observational cohort study analyzed 63 consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium’s ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University CA System (LUCAS™), and 5) estimated transfer time of < 30 minutes. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit. Results: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (92%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43%) were discharged from the hospital with CPC 1 or 2. Conclusions: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, good functionally favorable survival rates, safety, and appears potentially generalizable. Funding Statement: This community implementation program was made possible by a grant from the Leona M. and Harry B. Helmsley Charitable Trust Declaration of Interests: None of the authors have any financial or personal relationships with people or organizations that could have inappropriately influenced this study. Ethics Approval Statement: The Institutional Review Board at the University of Minnesota approved this study (No. 1703M11301) with waiver of informed consent.