ECMO ON THE STREETS OF PARIS
cardiac arrest with no-flow (i.e., no CPR) time
< 5 minutes; persistent ventricular fibrillation (v fib) or persistent signs of life. Results
from implementing on-scene ECMO show
an increase in survival rate from 8–29% with
acceptable neurological status (CPC 1 and 2). 11
The last step is the confirmation of the
results by a randomized study. In 2016, a mul-ticenter randomized study was commenced to
compare in-hospital and prehospital ECPR
implementation. Patients are randomized after
confirmation of refractory cardiac arrest eligible to ECPR. This study will include around
200 patients (Clinical Trials.gov identifier:
The objective is to clearly show that pre-hospital ECPR by emergency physicians is
possible inside and outside of Paris as well
as in other metropolitan areas and more
In Paris, prehospital ECPR is now a second
line of treatment for refractory v fib cardiac
arrest after the failure of conventional care.
The results are encouraging, but need to be
Several other teams have been trained to
follow the SAMU ECMO implementation
technique. Lyon, another large city in France,
and Madrid, the capital of Spain, have recently
started ECPR programs that include prehospital ECMO. Additional systems in Brussels,
Melbourne, London and cities in the United
States are looking to start prehospital ECPR
programs, some expecting to begin treating
patients in the field in 2018. JEMS
Alice Hutin, MD, MSc, is an emergency physician with Service
d’Aide Médicale Urgente (SAMU) in Paris, France.
Romain Corrocher, MD is an emergency physician with Ser-
vice d’Aide Médicale Urgente (SAMU) in Paris, France.
Floriant Loosli, CRNA, is a certified registered nurse anesthetist
with Service d’Aide Médicale Urgente (SAMU) in Paris, France.
Barbara Mantz, CRNA, is a certified registered nurse anesthetist with Service d’Aide Médicale Urgente (SAMU) in
Lionel Lamhaut, MD, PhD, is an emergency physician with
Service d’Aide Médicale Urgente (SAMU) in Paris, France, and an
associate professor of medicine at Descartes University in Paris.
Learn more from Lionel Lamhaut at the
EMS Today Conference, Feb. 21–23 in
Charlotte, N. C. EMS Today.com
1. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult advanced
cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and
emergency cardiovascular care. Circulation. 2015;132( 18 Suppl
2. Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation
with assisted extracorporeal life-support versus conventional
cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: An observational study and propensity analysis.
3. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest
treated with mechanical CPR, hypothermia, ECMO and early
reperfusion (the CHEER trial). Resuscitation. 2015;86:88–94.
4. Bellezzo JM, Shinar Z, Davis DP, et al. Emergency physician-initiated extracorporeal cardiopulmonary resuscitation. Resuscitation. 2012;83( 8):966–970.
5. Le Guen M, Nicolas-Robin A, Carreira S, et al. Extracorporeal
life support following out-of-hospital refractory cardiac arrest.
Crit Care. 2011; 15( 1):R29.
6. Wang CH, Chou NK, Becker LB, et al. Improved outcome of
extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest—A comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation.
7. Poppe M, Weiser C, Holzer M, et al. The incidence of “load &
go” out-of-hospital cardiac arrest candidates for emergency
department utilization of emergency extracorporeal life support: A one-year review. Resuscitation. 2015;91:131–136.
8. Kagawa E, Inoue I, Kawagoe T, et al. Assessment of outcomes
and differences bet ween in- and out-of-hospital cardiac arrest
patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation. 2010;81( 8):968–973.
9. Lamhaut L, Jouffroy R, Kalpodjian A, et al. Successful treatment
of refractory cardiac arrest by emergency physicians using
pre-hospital ECLS. Resuscitation. 2012;83( 8):e177–178.
10. Lamhaut L, Jouffroy R, Soldan M, et al. Safety and feasibility
of prehospital extra corporeal life support implementation by
non-surgeons for out-of-hospital refractory cardiac arrest.
Resuscitation. 2013;84( 11):1525–1529.
11. Lamhaut L, Hutin A, Puymirat E, et al. A pre-hospital extracorporeal cardio pulmonary resuscitation (ECPR) strategy
for treatment of refractory out hospital cardiac arrest: An
observational study and propensity analysis. Resuscitation.
The objective behind early dispatch and implementation of ECPR is to activate the ECMO pump within 60
minutes of collapse.