ECPR treatment saves cardiac arrest patients

About one third of cardiac arrest patients receiving ECPR (extracorporeal cardiopulmonary resuscitation) treatment survived and recovered with a good neurological outcome, according to a recent study conducted at The Helsinki-Uusimaa Hospital District (HUS).

When a patient suffers an out-of-hospital cardiac arrest, restoring blood circulation is not always possible despite quick and efficient emergency care.

ECPR is an operating model developed for these situations. The patient is given CPR during transport to the hospital and connected to an ECMO (extracorporeal membrane oxygenation) device for oxygenating blood during resuscitation.

The ECMO device, which has been used in cardiac surgical intensive care for a long time, has more recently been used with some cardiac arrest patients whose blood circulation could not be restored with standard resuscitation. This is referred to as ECPR treatment.

The purpose of the treatment is to support blood circulation during resuscitation, to enable the treatment of the cause of the cardiac arrest, and to create the preconditions for the recovery of the patient’s own circulation.

ECPR treatment can be given to a patient who meets the criteria and has no significant underlying diseases.

At HUS, the ECPR programme was launched in January 2016 as a collaboration between the Prehospital Emergency Care division of the Emergency Medicine and Services, the Heart and Lung Center, and the Perioperative and Intensive Care department.

Between 2016 and 2021, the physician-staffed mobile intensive care units in the HUS area participated in nearly three thousand resuscitation attempts of out-of-hospital cardiac arrest.

In 73 of these cases, the patient was transported with on-going CPR as an ECPR candidate to Meilahti hospital. Before ECPR decision, all patients received high-quality standard CPR treatment. The average age of the patients was 54, and more than 90% of them were male. In most cases, the cause of the cardiac arrest was a confirmed or suspected acute coronary syndrome.

The patients arrived at the hospital in an average of 57 minutes from the cardiac arrest and were connected to the ECMO device after an average of 85 minutes.

ECPR treatment was provided for 37 patients, which is just over half of those eligible for it. Eleven of these patients (30%) recovered from the cardiac arrest with a good neurological outcome. The blood circulation of a further eight patients was restored during transport to the hospital and the ECMO device was not required. Overall, 17 of the patients (23%) eligible for ECPR achieved a favourable outcome.

ECPR patients are among the most time-critical patient groups in emergency care.

“We have invested in training both in the field and in the hospital, which is why it’s great to see how well our results align with international comparisons”, said researcher and consultant physician Tuukka Puolakka of Emergency Medicine and Services.

Puolakka believes that the study provides a good starting point for developing the treatment of cardiac arrest patients in the future.

“The study showed that it’s worthwhile investing in patients eligible for ECPR. However, some patients have been excluded from the ECMO treatment, and the delay in starting the treatment has been longer than in other countries”, said Puolakka.

ECPR is a new form of treatment internationally, and the available research data is still limited.

“It’s very exceptional and encouraging that patients can recover from a cardiac arrest with such a long delay and such good outcomes”, said Markku Kuisma, Head of Prehospital Emergency Care of Emergency Medicine and Services.