- Amieth Yogarajah1,
- Manish M Verma1,
- Bruno Claro2,
- Simon J Finney3,
- Ben Singer3,4
- 1 Anaesthetics, The Royal London Hospital, Barts Health NHS Trust, London, UK
- 2 Perfusion, Barts Heart Centre, Barts Health NHS Trust, London, UK
- 3 Intensive Care Unit, Barts Health NHS Trust, London, UK
- 4 London’s Air Ambulance, The Royal London Hospital, London, UK
- Correspondence to Dr. Amieth Yogarajah, Anaesthetics, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK;
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- cardiac arrest
- extracorporeal membrane oxygenation
- extracorporeal cardiopulmonary resuscitation
There is increasing interest in the potential use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the prehospital setting to stabilise patients in refractory cardiac arrest.1 VA-ECMO involves draining blood through a cannula sited in a large vein and passing it through a pump and a membrane oxygenator before returning it under pressure through another cannula sited in a large artery. It can therefore be used to temporarily replace the function of the heart and lungs. When VA-ECMO is used to manage refractory cardiac arrest, it is termed extracorporeal cardiopulmonary resuscitation (ECPR).
Out-of-hospital cardiac arrest patients have poor outcomes,2 3 not least because it takes time to package and transport them to heart attack centres. By bringing VA-ECMO into the prehospital environment, it is hoped that vital organ perfusion can be re-established more quickly in a refractory cardiac arrest, preventing irreversible hypoxic organ damage and potentially improving out-of-hospital cardiac arrest survival rates that remain very low.
Prehospital ECPR is fraught with difficulties and potential complications,4 many of which can be prepared for by simulation. Unfortunately, there are no cost-effective, commercially available manikins designed for ECPR. Previous attempts at simulating prehospital ECPR have used separate manikins for the dichotomous elements of cardiopulmonary resuscitation (CPR) and extracorporeal membrane oxygenation (ECMO); however, this significantly reduces the fidelity of the exercise. In-hospital ECMO manikins often have to forego the use of …
Contributors Modification of the manikin was a joint effort by the five authors. SJF and BS sourced the manikin, and BC sourced the perfusion circuit and took the photographs. AY and MMV designed the simulation and wrote the manuscript, which was then reviewed by SJF and BS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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