title: Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program.
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.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT; Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: joseph.tonna@hsc.utah.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Tonna
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Mallin
authors.affiliation: Division of Cardiovascular Medicine, Interventional Cardiology Section, Department of Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Brigham R
authors.initials: BR
authors.lastname: Smith
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Youngquist
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Antigoni
authors.initials: A
authors.lastname: Koliopoulou
authors.affiliation: Division of Cardiovascular Medicine, Interventional Cardiology Section, Department of Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Frederick
authors.initials: F
authors.lastname: Welt
authors.affiliation: Cardiovascular Intensive Care Unit, Staff Nurse Operating Room, University of Utah, Salt Lake City, UT.
authors.forename: Kathleen Diane
authors.initials: KD
authors.lastname: Stoddard
authors.affiliation: Division of General Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Ram
authors.initials: R
authors.lastname: Nirula
authors.affiliation: Division of General Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Richard
authors.initials: R
authors.lastname: Barton
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: James Franklin
authors.initials: JF
authors.lastname: Fair
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Stephen
authors.initials: S
authors.lastname: McKellar
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D008021:Life Support Systems; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D016730:Program Development; D015397:Program Evaluation; D015996:Survival Rate; D014481:United States