Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an advanced form of traditional CPR. While traditional CPR involves chest compressions, breathing support, medications, and defibrillation, ECPR additionally integrates the use of ECMO during resuscitative efforts. It serves as a critical intervention that buys time to assess and hopefully address the root cause of the cardiac arrest, with the ultimate aim of restoring the patient’s natural heart function.

 

The frequency with which a medical center performs ECPR procedures significantly impacts patient outcomes. Research indicates that centers conducting fewer than 9-12 ECPR cases annually see a marked decline in success rates. Surprisingly, this low-volume scenario is more common than one might expect. Data shows that a mere 44 centers reported handling more than 6 ECPR cases per year, with only 10 centers exceeding 12 cases annually.

The Caseload Conundrum: Balancing Volume and Quality

Balancing patient selection and caseload presents a challenging dilemma. While stringent patient criteria can enhance outcomes, it also limits the number of cases treated. Furthermore, resource allocation must be carefully considered in relation to caseload. Increasing the number of cases treated is beneficial only to the point where it doesn’t compromise the quality of care. If expanding caseload leads to reduced effectiveness, the overall resource efficiency of the program may suffer.

 

The critical question then becomes: How can hospitals strike the delicate balance between maintaining adequate ECPR caseloads and ensuring optimal care quality? This is where specialised expertise becomes invaluable.

 

While Innovative ECMO Concepts (IEC) cannot directly influence the number of ECPR cases a hospital receives, our specialised knowledge and support can play a pivotal role in transforming a hospital’s ECPR capabilities.

 

Here are 5 potential ways IEC can help hospitals increase caseload:

1. Implementing Policies and Procedures (P&P):

 

IEC can help hospitals develop and implement comprehensive policies and procedures for their ECPR programs. This includes protocols for:

 

• Identifying key personnel
• Activation
• Cannulation
• Priming and initiation
• Equipment management

 

Having robust P&Ps in place can increase a hospital’s confidence and capability in handling ECPR cases, potentially leading to more cases being taken on.

1. Activation Plan Development:

 

A well-crafted activation plan is crucial for ECPR success. IEC can help hospitals design and implement rapid response protocols that ensure all necessary personnel and equipment are at the patient’s bedside within minutes of ECPR activation. This swift, coordinated response is vital for improving patient outcomes. As the hospital’s ECPR team becomes more adept at rapid deployment, they may feel more confident in their ability to handle these critical cases, potentially leading to increased willingness to initiate ECPR when appropriate.

1. Training and Education:

 

IEC offers comprehensive training programs tailored to each hospital’s specific needs. These programs cover all aspects of ECPR, from technical skills to the decision-making processes. By enhancing the knowledge and skills of the entire ECPR team, IEC helps build confidence and competence. As staff become more proficient and self-assured in their abilities, they may be more inclined to advocate for ECPR in suitable cases, potentially increasing the overall caseload.

1. Patient Selection Criteria:

 

Developing appropriate patient selection criteria is a delicate balance. IEC can help hospitals establish evidence-based guidelines that identify patients most likely to benefit from ECPR. While strict criteria can improve outcomes, overly restrictive guidelines can limit caseload. IEC’s expertise can help strike the right balance, potentially expanding the pool of eligible patients while maintaining good outcomes. This optimised approach often leads to a gradual increase in ECPR cases.

1. Outcome Expectations:

 

Understanding what constitutes success in ECPR is crucial for program sustainability. IEC can help hospitals set realistic expectations for ECPR outcomes, emphasising that even with optimal care, mortality rates may remain high in this patient population.

 

For patients who experience cardiac arrest outside of a hospital setting, traditional CPR alone results in only 7.5% surviving to hospital discharge.

However, when ECPR is employed, the survival rate increases to 30%—a four-fold improvement in outcomes.

 

By fostering a nuanced understanding of ECPR success, hospitals can maintain morale and continued engagement with their ECPR program. This realistic outlook can prevent discouragement and support ongoing use of ECPR in appropriate cases, potentially supporting a stable or increasing caseload over time.

 

Increasing ECPR Caseload Safely and Thoughtfully

IEC’s approach focuses on safely and thoughtfully increasing ECPR caseload, ensuring that hospitals can grow their ECPR programs responsibly, always prioritising patient care and quality outcomes over mere numbers. Through interventions such as refining policies and procedures and optimising activation plans, IEC empowers hospitals to enhance their ECPR capabilities and confidently manage an increased caseload.