Department of emergency medicine, collaborators use innovative method to improve cardiac arrest outcomes
Through ECPR, certain cardiac arrest patients have significantly better chances of full recovery
Dec. 5, 2022 — When a patient’s heart stops, it’s a race against the clock for medical teams to get it pumping again, with every second that passes increasing the chance of permanent damage to the brain and other organs.
Collaborators at UF Health Shands Hospital, including nursing teams, specialists and health providers in the departments of emergency medicine, surgery and anesthesiology at the College of Medicine, will soon officially roll out a new method of addressing cardiac arrest that has already proved to significantly improve the chances of patient revival and full recovery.
The stopping of the heart, or cardiac arrest, can be caused by a heart attack or a mechanical or electrical issue with the heart. During cardiac arrest, the heart, a muscle responsible for delivering oxygen-rich blood and removing carbon dioxide from blood throughout the body, can no longer accomplish this task when it’s not pumping. As a result, the body’s organs begin to shut down, often resulting in irreparable damage and death.
“Essentially up to half of those who survive have severe injuries to their brain, and the other half of those who survive have varying degrees of less severe disability,” said Torben K. Becker, M.D., Ph.D., chief of the division of critical care and director of the department of emergency medicine’s global health section. “Overall survival is somewhere between 10% and 15%, and it’s interesting to note that these numbers haven’t changed much over the decades. I started as an EMT 22 years ago, and the numbers were similar to what they are today.”
Improving chances of recovery
For the past few years, Becker and his colleagues have developed a new approach to increase the likelihood of recovery for cardiac arrest patients: extracorporeal cardiopulmonary resuscitation, or ECPR. As of January, ECPR will be fully administrable at UF Health Shands Hospital, which will have the resources and training to assist patients who qualify for ECPR.
Most patients undergo cardiac arrest outside a hospital setting, Becker said. After a bystander calls 911 and first responders arrive, the paramedics will administer CPR and potentially use a defibrillator in an effort to shock the heart back into working order for up to 20 minutes. Depending on the circumstances, the patient may then be transported to the emergency room if the heart has not successfully begun pumping on its own again. At that point, physicians will continue chest compressions, use artificial devices to help the patient breathe and administer certain medications in an effort to restart the heart.
Patients who qualify for ECPR therapy are identified by first responders upon their arrival. These patients exhibit characteristics that give them a greater chance for recovery, as calculated by an algorithm that weighs factors such as whether a patient has received bystander CPR within five minutes of the cardiac event or had an irregular heartbeat upon receiving chest compressions. With UF Health’s emergency procedures now updated to offer ECPR therapy, physician teams will be notified and an alert message will be sent out when a qualified patient is identified, so teams are prepared for their arrival.
ECPR uses an extracorporeal membrane oxygenation, or ECMO, machine to deliver oxygen-rich blood throughout the body and remove carbon dioxide. This is achieved by inserting cannulas — thin tubes — into an artery and a vein while artificial breathing and chest compressions are continued in the emergency room. Once the patient is connected to ECMO, the machine takes over the function of the heart and the lungs. After 96 hours connected to the ECMO machine, the patient’s condition is assessed and they may be released from care soon after.
“This therapy was pioneered in Australia and Europe before it became widespread in the United States, especially when it comes to application in the context of cardiac arrest,” Becker said. “And we’re looking at survival rates in those published studies between 30% to 50%. When the survival rate for these patients without this therapy is less than 5%, that is a significant improvement.”
He said UF Health Shands Hospital anticipates about 10 to 15 patients who qualify for ECPR therapy annually, and that about eight of those patients can achieve full recovery with this intervention.
“Those are patients who have good enough neurological recovery that they can walk unassisted and can go back to their home or living environment soon after hospitalization,” he said.
Bystander intervention key to saving lives
Becker said along with new methods like ECPR, bystander intervention is one of the most important ways to improve patient outcomes following cardiac arrest. UF Health’s PulsePoint task force, led by Becker and UF anesthesiologist Nikolaus Gravenstein, M.D. ’90, worked alongside first responders from the Alachua County Sheriff’s Office, Gainesville Fire Rescue and Alachua County Fire Rescue to integrate PulsePoint Respond, a free smartphone app that alerts bystanders to a nearby cardiac emergency, with Alachua County’s 911 system.
Since introducing PulsePoint to Alachua County in fall 2018, the rate of bystander CPR has increased from about 40% to over 65%.
“It’s a critical link in the chain that has led to us even being able to do an ECPR program,” Becker said. “Because bystander CPR is a requirement for ECPR therapy and our rate of bystander CPR has increased in recent years, the pool of potentially eligible patients has gone up as well. That’s great news, but it still leaves 35% of patients who never became eligible. I think it’s important to know that our work here is not done yet and we can’t rest on our laurels. As we keep pushing the needle on bystander CPR aid, every percentage point gained means another person gets a chance to become a candidate for this ECPR therapy and another opportunity to return home to their loved ones.”