Prehospital Extra-Corporeal Cardiopulmonary Resuscitation

Introduction Out-of-hospital cardiac arrest remains a global health problem. There is emerging evidence that the use of extra-corporeal membrane oxygenation during resuscitation [ECPR], may help to improve outcomes. Several prehospital services around the world are now able to provide on-scene ECPR. However, the early identification of patients is a key factor in enabling this level of response to OOHCA. This systematic review aims to identify prehospital ECPR systems and describe their patient selection criteria and dispatch processes. Methods A systematic literature search of the MEDLINE and Embase databases was performed between the dates of 4th April 2024 and 11th April 2024. Study registries were also reviewed to identify the protocols of ongoing or planned studies. Additionally, forwards and backwards reference tracing of eligible literature was performed to identify further articles. Results A total of ten studies were identified. When combined, criteria involving premorbid conditions were the most frequently utilised, in eight out of ten included studies. Age-related, the requirement for a witnessed cardiac arrest, resuscitation-related factors and ECPR-related factors were all used in seven studies. The use of an aetiology or presenting rhythm related criteria were both reported in five studies. The dispatch processes for ECPR teams were varied and included both helicopter and ground-based services. ECPR was planned to be performed on scene in nine systems, and one described the use of a rendezvous strategy. Conclusions Variability in the selection criteria and dispatch processes used by the identified ECPR services is likely to be reflective of the variation in geographical distribution, team composition and transport modes of prehospital EPCR services. Many eligibility criteria can be determined during emergency call receipt or shortly after resource arrival, highlighting the potential for improved screening by emergency medical dispatchers and non-specialist resources.