Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest
This French prehospital study of ECLS is the first ever feasibility trial of use of this modality for prehospital cardiac arrest management.
They trained a team of prehospital resuscitationists : 2 doctors, 1 nurse, 1 paramedic and 1 ‘logistician’. This team would respond to out of hospital cardiac arrests within the Paris region by road to provide a second tier backup to primary ALS ambulance teams. They would make a decision if standard ACLS was not producing ROSC then prehospital ECLS protocol would be initiated. Intubation/ventilation and mechanical chest compression devices were generally already instituted by time of arrival of the ECLS team.
The prehospital ECLS team trained for a simple technique of ECLS catheter insertion, not reliant on ultrasound.
THis involved a surgical cut down to expose the femoral vessels then insertion of arterial and venous catheters. A portable membrane oxygenator device ( Maquet) was then connected, packed red cells and plasma transfusion was given. Dobutamine and noradrenaline infusions were initiated to target MAP >60mmHg. Therapeutic hypothermia was induced with chilled saline.
Results : 7 patients treated with prehospital ECLS. 1 survived without neurologic sequelae. The rest died but 2 were able to donate organs. Average time from start of ACLS to ECLS was 57 min. Average time from skin incision to start of ECLS was 22 min.
Remember all 7 patients were failing standard ACLS treatment for over 40 min until ECLS was initiated. 1 survived – in that case it took 75 min from start of ACLS to ECLS. Went home with no signs of brain injury! True reanimation!