Eligibility of out-of-hospital cardiac arrest patients for extracorporeal cardiopulmonary resuscitation in the United States: A geographic information system model

Adam L. Gottula, Christopher R. Shaw, Kari L. Gorder, Bennett H. Lane, Jennifer Latessa, Man Qi, Amy Koshoffer, Rabab Al-Araji, Wesley Young, Jordan Bonomo, James R. Langabeer, Demetris Yannopoulos, Timothy D Henry, Cindy H. Hsu, Justin L. Benoit

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: Recent evidence suggest that extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers. Methods: We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. The combined model was used to estimate the total number of ECPR candidates. Results: There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were deemed eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model. Conclusions: Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies.

Original languageEnglish (US)
Pages (from-to)111-120
Number of pages10
JournalResuscitation
Volume180
DOIs
StatePublished - Nov 2022

Bibliographical note

Funding Information:
We would like to acknowledge The Cardiac Arrest Registry to Enhance Survival (CARES), CARES participating sites (https://mycares.net/sitepages/map.jsp), the Max Harry Weil Institute for Critical Care Research and Innovation (MCIRCC), Opeolu M Adeoye, MD, MS, Bryan McNally, MD, MPH, Marylou Cardenas-Turanzas, MD, DrPH, and Joseph Tonna, MD, MS for their support of this project. None. The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Adam L. Gottula declares no conflicts of interest. Christopher R. Shaw declares no conflicts of interest. Kari L. Gorder declares no conflicts of interest. Bennett H. Lane declares relevant COI. Reports receiving consulting fees, holding equity interest in TriAxia Health. Wesley Young declares no conflicts of interest. Man Qi declares no conflicts of interest. Jennifer Latessa declares no conflicts of interest. Amy Koshoffer declares no conflicts of interest. Rabab Al-Araji declares no conflicts of interest. Jordan Bonomo declares no relevant conflicts of interest. Reports receiving consulting fees from Genentech Inc. James Langabeer declares no conflicts of interest. Demetri Yannopoulus declares no conflicts of interest. Cindy H. Hsu declares no conflicts of interest, Tim D. Henry declares no conflicts of interest. Justin L. Benoit declares no conflicts of interest.

Publisher Copyright:
© 2022 Elsevier B.V.

Keywords

  • Cardiopulmonary resuscitation
  • Emergency medical services
  • Extracorporeal cardiopulmonary resuscitation
  • Extracorporeal membrane oxygenation
  • Geographic Information Systems
  • Out-of-hospital cardiac arrest

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