期刊
出版社
BMC
DOI: 10.1186/s13049-022-01064-8
关键词
Emergency medical services; Extracorporeal cardiopulmonary resuscitation; Cardiac arrest; Accessibility
资金
- New South Wales Health, translation research Grant scheme
- iMOVE CRC
- Cooperative Research Centres program
- Australian Government initiative
- National Heart Foundation of Australia
- Metro North Hospital and Health Services Clinician-Research Fellowship [105849]
The study aimed to determine the best ECPR delivery strategy for optimal patient access, examine the time-sensitivity of ECPR in predicting survival, and model potential survival benefits from different ECPR delivery strategies. The results showed that the rendezvous and pre-hospital ECPR models significantly increased the catchment area of eligible OHCA patients.
Background :The use of extracorporeal membrane oxygenation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) patients is usually implemented in-hospital. As survival in ECPR patients is critically time-dependent, alternative models in ECPR delivery could improve equity of access.Objectives: To identify the best strategy of ECPR delivery to provide optimal patient access, to examine the time-sensitivity of ECPR on predicted survival and to model potential survival benefits from different delivery strategies of ECPR.Methods: We used transport accessibility frameworks supported by comprehensive travel time data, population density data and empirical cardiac arrest time points to quantify the patient catchment areas of the existing in-hospital ECPR service and two alternative ECPR strategies: rendezvous strategy and pre-hospital ECPR in Sydney, Australia. Published survival rates at different time points to ECMO flow were applied to predict the potential survival benefit.Results: With an in-hospital ECPR strategy for refractory OHCA, five hospitals in Sydney (Australia) had an effective catchment of 811,091 potential patients. This increases to 2,175,096 under a rendezvous strategy and 3,851,727 under the optimal pre-hospital strategy. Assuming earlier provision of ECMO flow, expected survival for eligible arrests will increase by nearly 6% with the rendezvous strategy and approximately 26% with pre-hospital ECPR when compared to the existing in-hospital strategy.Conclusion: In-hospital ECPR provides the least equitable access to ECPR. Rendezvous and pre-hospital ECPR models substantially increased the catchment of eligible OHCA patients. Traffic and spatial modelling may provide a mechanism to design appropriate ECPR service delivery strategies and should be tested through clinical trials.
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