6: PECMO: Implementing the First Pre-Hospital ECMO Service in the Middle East. A Model of Rapid Access and Enhanced Survival

Background: Out-of-hospital cardiac arrest (OHCA) is a critical condition with low survival rates, often due to limited immediate intervention options, particularly in refractory cases.[1,2] Pre-hospital extracorporeal membrane oxygenation (PECMO) programs have been created in several countries with remarkable patient outcomes and improved survival. [3] In April 2023, we launched the first PECMO service in the Middle East to address this gap by providing rapid extracorporeal cardiopulmonary resuscitation (ECPR) to selected patients with high recovery potential. Methods: In collaboration with Magen David Adom (MDA), we equipped an ECMO ambulance and staffed it with an ICU physician, an ED physician, and an ICU nurse, facilitating rapid deployment and on-scene ECMO initiation. Over several months, we treated 18 patients meeting strict criteria: witnessed cardiac arrest, initial shockable rhythm, no-flow time ≤ 5 minutes, age ≤ 65, and absence of significant comorbidities. Primary indications included suspected cardiac-origin arrests, with shockable rhythms in most cases. Approval of the institutional ethics committee was provided for the patient’s information (no. 0077-23-ASF). Results: Among 18 patients (94% male), 17 had STEMI as the primary cause. Two achieved return of spontaneous circulation (ROSC) prior to ECMO initiation. Sixteen patients (89%) survived to hospital admission; six (33%) were weaned from ECMO and discharged from ICU. Neurological outcomes at discharge varied, with cerebral performance categories (CPC) ranging from 1 to 6. ECMO-related complications were common, including bleeding at cannulation sites (72%) and acute kidney injury (72%). Additional interventions included cardiac catheterization (56%) and renal replacement therapy (17%). Conclusion: Our pre-hospital ECMO program demonstrates promising survival rates in selected OHCA patients, indicating the feasibility and life-saving potential of ECPR in an urban pre-hospital setting. Continued refinement of patient selection, training, and logistics will be critical to improving outcomes and expanding the program’s reach.