PCI center with ongoing mechanical chest com-
pressions may change how refractory cardiac arrest
victims are treated.
Success of such programs, particularly in the
beginning, will depend on careful selection of
appropriate patients. This novel approach consists of rapid transport of refractory out-of-hospital
v fib cardiac arrest patients with mechanical chest
compressions in route to the destination of an
ECLS-capable medical facility, where rapid introduction of circulatory support can be achieved in
either the ED or catheterization lab.
Simultaneous induction of therapeutic hypothermia ( 34 degrees C) and coronary angiography and PPCI are crucial to correct the underlying
cause of the refractory arrest, and to ensure optimal neurological function of survivors.
Continuing ECMO support for the profound
post-resuscitation left ventricular dysfunction
associated with prolonged cardiac arrest is also
critical to achieve long-term positive outcomes
with this approach.
Early reports, though admittedly containing
small numbers, suggest significant improvements
in neurologically intact survival can be achieved
with this new paradigm of “load and go” or “scoop
and treat on the way.”
EMS agencies and their medical directors are
encouraged to work with their specialty hospital
facilities, as they have in Alameda County, Calif.,
to ensure that ECMO capabilities are available and
can be alerted similar to prehospital STEMI alerts,
to be able to fulfil this new treatment paradigm in
their EMS system. ✚
Karl B. Kern, MD, is a professor of Medicine at the University of Arizona. He’s also the Gordon A. Ewy, MD, Distinguished Endowed Chair of Cardiovascular Medicine
and is co-director of the Sarver Heart Center. He may be
contacted at firstname.lastname@example.org.
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