• Anna Condella, Nicholas S Simpson, Kyle S Bilodeau, Barclay Stewart, Samuel Mandell, Mark Taylor, Beth Heather, Eileen Bulger, Nicholas J Johnson, and Matthew E Prekker.
• Department of Emergency Medicine, University of Washington, Seattle, WA; Trauma & ECLS Programs, Harborview Medical Center, University of Washington, Seattle, WA. Electronic address: alc127@uw.edu.
• Ann Emerg Med. 2024 Nov 1; 84 (5): 560569560-569.

AbstractExtracorporeal cardiopulmonary resuscitation (ECPR) is a form of intensive life support that has seen increasing use globally to improve outcomes for patients who experience out-of-hospital cardiac arrest (OHCA). Hospitals with advanced critical care capabilities may be interested in launching an ECPR program to offer this support to the patients they serve; however, to do so, they must first consider the significant investment of resources necessary to start and sustain the program. The existing literature describes many single-center ECPR programs and often focuses on inpatient care and patient outcomes in hospitals with cardiac surgery capabilities. However, building a successful ECPR program and using this technology to support an individual patient experiencing refractory cardiac arrest secondary to a shockable rhythm depends on efficient out-of-hospital and emergency department (ED) management. This article describes the process of implementing 2 intensivist-led ECPR programs with limited cardiac surgery capability. We focus on emergency medical services and ED clinician roles in identifying patients, mobilizing resources, initiation and management of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the ED, and ongoing efforts to improve ECPR program quality. Each center experienced a significant learning curve to reach goals of arrest-to-flow times of cannulation for ECPR. Building consensus from multidisciplinary stakeholders, including out-of-hospital stakeholders; establishing shared expectations of ECPR outcomes; and ensuring adequate resource support for ECPR activation were all key lessons in improving our ECPR programs.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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