Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program - 27/09/17

Doi : 10.1016/j.annemergmed.2016.10.001

Joseph E. Tonna, MD ^a,^b,^⁎ , Craig H. Selzman, MD, FACS ^a, Michael P. Mallin, MD ^b, Brigham R. Smith, MD ^d, Scott T. Youngquist, MD, MSc ^b, Antigoni Koliopoulou, MD ^a, Frederick Welt, MD ^d, Kathleen Diane Stoddard, RN, BSN, CCRN ^e, Ram Nirula, MD, MPH, FACS ^c, Richard Barton, MD ^c, James Franklin Fair, MD ^b, James C. Fang, MD, FACC, FAHA ^f, Stephen McKellar, MD, MSc ^a
^a Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
^b Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
^c Division of General Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
^d Division of Cardiovascular Medicine, Interventional Cardiology Section, Department of Medicine, University of Utah, Salt Lake City, UT
^e Cardiovascular Intensive Care Unit, Staff Nurse Operating Room, University of Utah, Salt Lake City, UT
^f Division of Cardiovascular Medicine, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT

^∗Corresponding Author.

Abstract

Despite advances in the medical and surgical management of cardiovascular disease, greater than 350,000 patients experience out-of-hospital cardiac arrest in the United States annually, with only a 12% neurologically favorable survival rate. Of these patients, 23% have an initial shockable rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), a marker of high probability of acute coronary ischemia (80%) as the precipitating factor. However, few patients (22%) will experience return of spontaneous circulation and sufficient hemodynamic stability to undergo cardiac catheterization and revascularization. Previous case series and observational studies have demonstrated the successful application of intra-arrest extracorporeal life support, including to out-of-hospital cardiac arrest victims, with a neurologically favorable survival rate of up to 53%. For patients with refractory cardiac arrest, strategies are needed to bridge them from out-of-hospital cardiac arrest to the catheterization laboratory and revascularization. To address this gap, we expanded our ICU and perioperative extracorporeal membrane oxygenation (ECMO) program to the emergency department (ED) to reach this cohort of patients to improve survival. In this report, we illustrate our process and initial experience of developing a multidisciplinary team for rapid deployment of ED ECMO as a template for institutions interested in building their own ED ECMO programs.

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Plan

	Supervising editor: Keith A. Marill, MD
	Author contributions: All authors made substantial contributions to all of the following: concept and design of the study, acquisition of data, and analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be submitted.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. Dr. Welt reports receiving consulting fees from Medtronic Advisory Board outside the scope of the submitted work.
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