Morning equipment inspection by the Physician Response Unit. From left to right: Paramedic Jonna Kilponen, EMS Physician Tuukka Puolakka, and Paramedic Jami Kurki. Photo: HUS / Selma Savage

Science and technology

A groundbreaking extracorporeal blood oxygenation treatment known as ECPR (extracorporeal cardiopulmonary resuscitation) has shown promising results in saving the lives of cardiac arrest patients, according to a recent study conducted at HUS.

Cardiac arrest is a life-threatening emergency, and despite quick and efficient emergency care, restoring blood circulation is not always possible.

In such cases, ECPR provides a lifeline. This innovative treatment involves giving cardiopulmonary resuscitation (CPR) to the patient while transporting them to the hospital, where they are connected to an ECMO (extracorporeal membrane oxygenation) device. The ECMO device, traditionally used in cardiac surgical intensive care, serves to oxygenate the patient's blood during resuscitation.

The ECPR treatment aims to support blood circulation during resuscitation, address the underlying cause of cardiac arrest, and create the conditions necessary for the patient's circulation to recover. To qualify for ECPR, patients must meet specific criteria and have no significant underlying diseases. HUS initiated its ECPR program in January 2016, involving collaboration between the Prehospital Emergency Care division of the Emergency Medicine and Services, the Heart and Lung Center, and the Perioperative and Intensive Care department.

Between 2016 and 2021, HUS physician-staffed mobile intensive care units conducted nearly three thousand resuscitation attempts for out-of-hospital cardiac arrest cases. In 73 of these cases, patients were transported to Meilahti hospital while undergoing CPR, making them candidates for ECPR. Before the decision to proceed with ECPR, all patients received high-quality standard CPR treatment. The study population had an average age of 54, with more than 90% being male. In most instances, the cause of cardiac arrest was either a confirmed or suspected acute coronary syndrome.

The results from this study are in line with international comparisons. Patients arrived at the hospital within an average of 57 minutes from the onset of cardiac arrest and were connected to the ECMO device after an average of 85 minutes. ECPR treatment was administered to 37 patients, just over half of those eligible. Remarkably, 11 of these patients (30%) recovered from the cardiac arrest with a favorable neurological outcome. An additional eight patients had their blood circulation restored during transportation to the hospital, eliminating the need for ECMO. Overall, 17 of the patients (23%) eligible for ECPR achieved a positive outcome.

ECPR patients constitute one of the most time-critical groups in emergency care. "We have invested in training both in the field and in the hospital, which is why it's great to see how well our results align with international comparisons," said researcher and consultant physician Tuukka Puolakka from Emergency Medicine and Services.

Puolakka believes that this study lays the foundation for the future development of cardiac arrest patient treatment. "The study demonstrates that investing in patients eligible for ECPR is worthwhile. However, some patients were excluded from ECMO treatment, and the initiation of treatment was sometimes delayed compared to other countries," Puolakka noted.

ECPR represents a relatively new treatment option globally, and research data on its effectiveness is still limited. "It's exceptionally encouraging to witness patients recovering from cardiac arrest even with significant delays and achieving such positive outcomes," said Markku Kuisma, Head of Prehospital Emergency Care at Emergency Medicine and Services. The findings offer hope for the future of cardiac arrest treatment and may pave the way for broader adoption of ECPR as a life-saving intervention.