• Samir Ali, Xavier Moors, Hans van Schuppen, Lars Mommers, Ellen Weelink, Christiaan L Meuwese, Merijn Kant, Judith van den Brule, Carlos Elzo Kraemer, VlaarAlexander P JAPJDepartment of Intensive Care Medicine, Amsterdam University Medical Centre, Amsterdam, 1105 AZ, the Netherlands., Sakir Akin, Annemiek Oude Lansink-Hartgring, Erik Scholten, Luuk Otterspoor, Jesse de Metz, Thijs Delnoij, van LieshoutEsther M MEMMTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands., Robert-Jan Houmes, HartogDennis denDDTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands., Diederik Gommers, and Dinis Dos Reis Miranda.
• Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands. s.ali@erasmusmc.nl.
• Scand J Trauma Resus. 2024 Apr 17; 32 (1): 3131.

BackgroundThe likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients.MethodsThe ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18-50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months.DiscussionThe ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment.Trial RegistrationClinicaltyrials.gov under NCT04620070, registration date 3 November 2020.© 2024. The Author(s).

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