ILCOR
ASAP
ECMO
ASAP PRO is the only cardiac arrest treatment protocol prepared to utilize the 2023 ILCOR recommendations regarding the utilization of ECMO in patients experiencing cardiac arrest.
I'm proud to have served on aeromedical teams responsible for the transport and care of patients undergoing ECMO therapy. I observed a noticeable rise in the number of ECMO flights as I approached the conclusion of my flying service as well as increased use in the hospital setting. ASAP proactively developed the only protocols that incorporate training and testing specific to prehospital ECMO procedures.
Efficacy of ECMO in Cardiopulmonary Resuscitation
We suggest extracorporeal cardiopulmonary resuscitation (ECPR) may be considered as a rescue therapy for selected adults with out-of-hospital cardiac arrest when conventional cardiopulmonary resuscitation is failing to restore spontaneous circulation, in settings where this can be implemented (weak recommendation, low certainty of evidence). ILCOR 2023
The reality of Prehospital ECMO
Extracorporeal Membrane Oxygenation (ECMO) must be integrated as a core element of all emergency cardiac arrest protocols.
University of Minnesota Foundation
“This could be, and probably will be, watched by other cities, and the results will affect how emergency response medical teams can change their practices,” Dr. Yannopoulos says. “Do we bring the patient to the hospital, or do we bring the hospital to the patient if it’s safer and faster for them? That’s something that I think is a fundamental question of delivery of care in our field, and I think we have high value for our community.”
The Mayo Clinic
Feb 15, 2023 (web)
Only about 8% of patients who have cardiac arrest outside of a hospital survive. That rate is even lower for certain patients who do not respond to defibrillation. A new service being launched by Mayo Clinic Ambulance in Rochester, Minnesota, is hoping to improve outcomes and save more lives by getting patients faster access to extracorporeal membrane oxygenation (ECMO)
Sample Criteria Eligibility for ECMO Therapy
An essential assessment for all Adult OHCA
Criteria for extracorporeal cardiopulmonary resuscitation (ECPR) include:
- Patient age: Typically between 18 and 75 years old
- Cardiac arrest: Witnessed, with a suspected cardiac origin
- CPR: Continuous CPR within 10 minutes of recognizing cardiac arrest
- Rhythm: Initial or persistent ventricular fibrillation (VF) or ventricular tachycardia (VT)
- Bystander CPR: CPR performed by a bystander
- No-flow time: Less than 5 minutes from cardiac arrest to CPR, and less than 60 minutes from cardiac arrest to ECMO
- etCO2: Greater than 10 mm Hg (1.3 kPa) before ECMO cannulation
- Comorbidities: No significant life-limiting comorbidities
- Aortic valve incompetence: No greater than mild aortic valve incompetence
- Patient wishes: In accordance with the patient's presumed wishes
Exclusion criteria for ECMO include:
- Do-not-resuscitate order
- End-organ dysfunction
- Suspected aortic dissection
- Terminal heart failure
- Severe pulmonary disease
- Disseminated oncologic disease
- Obvious or suspected pregnancy
- Bilateral femoral bypass surgery
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The ASAP Protocol curriculum serves as a substitute for specific American Heart Association (AHA) certifications, including CPR/AED for lay responders and Basic Life Support (BLS) for Healthcare Providers (HCP). Furthermore, the ASAP Pro certification is intended to enhance and support Advanced Cardiovascular Life Support (ACLS) courses.
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