Implementation of emergency extracorporeal membrane oxygenation in a hospital without on-site cardiothoracic surgery support

Sep 30, 2026

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Extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is presented as a feasible approach for refractory cardiac arrest and associated shock or respiratory failure in a rural hospital lacking on-site cardiothoracic surgery support. The ECPR protocol was initiated in June 2020 in North Karelia Central Hospital and patients were transferred to Kuopio University Hospital for tertiary care. From June 2020 to June 2024, 15 patients received ECPR; three (20%) were alive at six months with favorable neurological outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Abstract

Introduction

Methods

Patients and methods

Implementation of ECPR protocol

R E S U S C I T A T I O N P L U S 2 7 ( 2 0 2 6 ) 1 0 1 1 86 Original Article Implementation of emergency extracorporeal membrane oxygenation in a hospital without onsite cardiothoracic surgery support Sanna-Maria Pohjanpaju a, Sirkku Heinoa, Sampsa Suvelaa, Antti Eranti b, Stepani Bendelc, Timo Nyyss¨onenc, Sanna Uskelab, Anu Taskinen b, Sakari Syv¨aojaa, Marko Hoikkad,e, Matti Reinikainenc, f, Tuomas T. Rissanenb, f,* Abstract Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option for refractory cardiac arrest patients, but it has mostly been restricted to hospitals with on-site cardiothoracic surgery support. We report the implementation of the ECPR protocol in a rural hospital without on-site cardiothoracic surgery. Methods: The ECPR protocol was initiated in June 2020 in North Karelia Central Hospital in Eastern Finland, in collaboration with the tertiary center, Kuopio University Hospital, where patients were transferred for further treatment. After successful initiation of the ECPR protocol, the emergency ECMO treatment was extended to patients with refractory cardiogenic shock or respiratory failure. We retrospectively analyzed patient outcomes. Results: Between June 2020 and June 2024, 15 patients suffering from refractory cardiac arrest were treated with ECPR. The median age of the patients was 56 years [interquartile range (IQR) 46–63] . Ten (67 %) patients were treated because of out-of-hospital cardiac arrest and five (33 %) patients because of in-hospital cardiac arrest. The median time from cardiac arrest to VA-ECMO was 58 (IQR 37–65) min. At six months, three (20 %) ECPR patients were alive with a favorable neurological outcome. In addition, one patient with cardiogenic shock was treated successfully with VA-ECMO and one respiratory failure patient with VV-ECMO. Conclusion: The ECPR protocol involving the initiation of emergency VA-ECMO in a hospital without on-site cardiac surgery and transfer to a tertiary center for further treatment is feasible and led to the survival of 20 % of the ECPR-treated patients and 25 % of all VA-ECMO-treated patients. Keywords: ECPR, VA-ECMO, Resuscitation, Cardiac arrest, Cardiogenic shock Introduction Cardiac arrest (CA) is a major global health problem with high mortality.1 The annual incidence of out-of-hospital cardiac arrest (OHCA) and emergency medical service (EMS) attempted resuscitations varies globally between 40.8–100.2 per 100,000 .2 After OHCA, the overall survival to hospital discharge is less than 10 % .3 The incidence of in-hospital cardiac arrest (IHCA) varies between 1.2 and 2.2 per 1000 hospital admissions, with reported survival to hospital discharge between 18 and 45 % .4–6 The chain of survival from cardiac arrest consists of early recognition of CA and basic and advanced life support, most importantly high-quality chest compressions and deﬁbrillation.7 To improve survival of CA, extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VAECMO) has been introduced as a treatment option.8 ECPR protocols have mostly been restricted to hospitals with onsite cardiothoracic surgery, leaving a signiﬁcant proportion of the population without the possibility of this potentially life-saving treatment.9–11 To improve the survival of patients suffering from refractory CA, we started an ECPR protocol involving the initiation of emergency ECMO treatment in North Karelia Central Hospital and then transferring the patients to Kuopio University Hospital, which is the tertiary ECMO center in Eastern Finland. After successful initiation of the ECPR protocol, the emergency ECMO treatment was * Corresponding author at: Heart Center, North Karelia Central Hospital, Siun Sote, Joensuu, Finland. E-mail address: Tuomas. Rissanen@siunsote.ﬁ (T.T. Rissanen) . [https://doi.org/10.1016/j.resplu.2025.101186

FAQs

What problem does the document address regarding ECPR and ECMO services?

ECPR using VA-ECMO is described as an option for refractory cardiac arrest, but it has largely been limited to hospitals with on-site cardiothoracic surgery support. The document reports implementation in a rural hospital without such support, using transfer to a tertiary center.

Where and when was the ECPR protocol implemented?

The protocol was initiated in June 2020 at North Karelia Central Hospital in Eastern Finland. Patients were managed initially there and then transferred to Kuopio University Hospital for further treatment.

What were the key outcome results reported for ECPR-treated patients?

Between June 2020 and June 2024, 15 refractory cardiac arrest patients received ECPR. At six months, three (20%) were alive with favorable neurological outcomes, and additional VA-ECMO or VV-ECMO treatments were described for specific shock or respiratory failure cases.

Sep 30, 2026

Uploaded by Ophelia