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Episode Overview: In this episode, Scott and Caleb dive into a crucial topic that could revolutionize cardiac arrest care: ECMO CPR (Extracorporeal Membrane Oxygenation CPR). Joined by Dr. Frank Ford and Dr. Colin McCloskey, they explore how ECMO can be a game changer in the management of cardiac arrest and the integration of EMS in these life-saving interventions. Cleveland has been a leader in implementing ECMO CPR, and now, with the Cleveland Clinic joining forces, this life-saving treatment is expanding.

Key Topics Covered:

1. What is ECMO?

   • ECMO stands for Extracorporeal Membrane Oxygenation, essentially a heart-lung machine that oxygenates the blood outside the body.

   • The procedure involves draining blood, pumping it through an oxygenator, and returning it to the body, supporting the heart and lungs.

2. Types of ECMO:

   • VV ECMO (Venovenous): Supports lung function.

   • VA ECMO (Venoarterial): Supports both the heart and lungs, crucial in ECMO CPR for patients in cardiac arrest.

3. The ECMO CPR Process:

   • Used for cardiac arrest patients, ECMO buys time, supporting vital organs until a fixable cause (like coronary occlusion or pulmonary embolism) can be treated.

   • Ideal candidates are those with witnessed cardiac arrest, limited low-flow time, and specific fixable conditions such as VF/VT, PE, or overdoses.

4. Role of EMS in ECMO CPR:

   • EMS plays a critical role in identifying candidates for ECMO CPR, mobilizing quickly, and transporting patients to an ECMO-capable facility.

   • Field criteria, operational changes, and quick decision-making are essential for success.

   • Education and training are key to ensuring EMS providers can identify ECMO candidates early.

5. Challenges and Operational Considerations:

   • Timely transport and ECMO initiation are vital, with a window of about 60 minutes for optimal neurological outcomes.

   • Discussions on how to expand ECMO availability across more hospitals in the region and the logistical challenges involved in larger-scale operations.

6. Future Directions:

   • ECMO CPR is growing, with programs expanding across major U.S. cities like Cleveland, New York, Boston, and Los Angeles.

   • The future of cardiac arrest care is likely to incorporate ECMO CPR as a standard for treating shockable rhythms in certain geographic areas.

7. Outcomes and Survival Rates:

   • Dr. McCluskey and Dr. Ford share promising data from Cleveland’s ECMO CPR program: about 50% of patients cannulated have survived neurologically intact, far exceeding traditional CPR outcomes.

   • Continuous refinement of criteria and operational systems could expand the catchment area and bring ECMO to more patients in need.

Takeaways for EMS Providers:

• ECMO CPR has the potential to drastically improve outcomes in cardiac arrest patients, but its success relies on early identification, fast transport, and proper training of EMS personnel.

• EMS providers should stay informed about ECMO programs in their region and be prepared for changes in the standard protocols for cardiac arrest management.

Quotes from the Episode:

• “All ECMO is, is time with a price. You want to take patients that have the highest possibility of a good neurologic outcome and bridge them to a therapy or give them time for their pathology to resolve itself.”

• “The future of cardiac arrest care is ECMO CPR, just like thrombectomy became the standard for large vessel occlusion strokes.”

From The Episode