Minn. first responders, Mayo Clinic teams introduce new cardiac arrest protocol

Patients who may benefit from ECMO will be moved to an emergency department sooner

By Matthew StollePost-Bulletin

ROCHESTER, Minn. — Local first responders and Mayo Clinic teams are changing the way they respond to cardiac arrest patients by including new protocols to identify patients that would benefit from early access to extracorporeal membrane oxygenation — often referred to as an ECMO machine.

An ECMO machine is a device that takes over heart and lung functions. The machine is similar to the heart-lung bypass machine used in open-heart surgery. Over the years, the technology has improved and found to have wider application than just in surgery.

Research has shown for a small subset of cardiac patients, an ECMO can act as a bridge in a hospital emergency room for "interventions that can help the patient most," said Dr. Anuradha Luke, medical director for Mayo Clinic ambulance.

Previously, first responders and paramedics would spend most of their time "in the field," where the patient had suffered the cardiac arrest, working through protocols and medications to revive the patient until every effort was exhausted.

Now for some patients judged to benefit from the new therapy, the work of resuscitating the patient will be moved earlier to an emergency room where an ECMO machine can be used.

"The evidence would show that it's a patient who can get a shock, but then the shock doesn't fix it. And in the past, we've run those protocols over and over in the field. And, unfortunately, we find those patients don't have a good outcome," said Dr. Alexander Finch, a Mayo Clinic emergency medicine physician who has helped lead the initiative.

"But we are hopeful with this new protocol that a very specific patient group could benefit from this therapy," he said.

Local first responders and Mayo's emergency department will begin using the new protocols on Friday. A recent study published in "The Lancet" found that the odds of surviving rose by six times if those patients had early access to ECMO and chest compressions.

Officials say previous Rochester cardiac patients have been rushed to the hospital and outfitted with an ECMO machine. What's new, they say, is the creation of a streamlined process, as well as "changing some of our approach to cardiac arrest in the pre-hospital environment," said Dr. Aaron Klassen, Mayo Clinic medical director for clinical practice and ambulance service. It also involves close coordination between the various agencies involved, including Mayo Clinic Ambulance Service and Rochester Fire Department.

Even as they shorten the time spent on the patient in the field, the goal is to continue to provide high-quality care even as the patient is moved to the hospital.

Medical officials estimate that eight cardiac arrest patients per year will qualify for the therapy. That may not seem like a lot, but the life-saving potential could grow over time, officials said.

"Cardiac arrest is one of the problems that we treat in the pre-hospital environment that has the worst chance of survival," Klassen said. "This program gives a few of them a much better chance of survival."

Medical officials view ECMO therapy as adding a new link in the chain to enhance the survivability of cardiac arrest patients. It starts at the beginning when a person who suffers a cardiac arrests is able to receive CPR as quickly as possible. That underscores the importance of getting CPR training.

Another key criterion for ECMO therapy eligibility, officials say, is whether, in the early moments of trying to revive the patient in the field, a patient has a "shockable heart." That says something about the patient's physiology. There may be enough resilience left in terms of the circulation of the blood through the brain and other vital organs that they have a good chance of survival.

If the patient is viewed as meeting this criteria and the emergency crew is within 30 minutes of Mayo's emergency department, the patient will be transported to the hospital.

More than 356,000 sudden cardiac arrests occur outside a hospital in the U.S. every year, according to the American Heart Association.

"It's really exciting to be on the progressive edge of medicine and have the support from our physician-led leadership to be able to implement new things like this," said Kate Arms, operations manager for Mayo Clinic Ambulance.

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