ECMO ambulance and Interdisciplinary emergency medical care David Macku Department of Cybernetics Czech Technical University Prague, Czech Republic

Our project is intended to improve outcomes for out-of-hospital patients suffering from cardiac and circulatory arrest. Out-of-hospital patients with cardiac and circulatory arrest represent the most at risk cardiac group with the worst results. The quality of provided emergency medical care for these patients varies from state to state, from city to city.

Jan Kaplicky Michael Jackson

Jan Kaplicky A famous Czech architect He died at the day of his daughter's birth

Jan Kaplicky Cardiac and Circulatory arrest in Prague Resuscitation by bystanders on the street Resuscitation by Emergency medical care personnel Unsuccessful external defibrillations After 40 min unsuccessful resuscitation, he was declared dead on the street without knowing the real cause of death Cause of death – heart attack (post mortem)

Michael Jackson Cardiac and circulatory arrest in Los Angeles Resuscitation at home Resuscitation during the time of transportation into the hospital, at the hospital Death declared 2 hours after arrival at the hospital Cause of death - intoxication

Similarities Differences Cardiac arrest Circulatory arrest Skilled resuscitation by EMS personnel Place of death Cause of death Time of resuscitation

Interdisciplinary clinical pathway We need clearly defined protocols for everyone who participates in saving the lives of these patients Utilization of the high-tech medical know-how

Peripheral VA ECMO Implementation by an experienced specialist outside of the hospital for ensuring blood oxygenation and circulation outside the patient's body regardless of the activity of heart or lungs Our aim is to maintain tissue reperfusion, particularly to the brain as soon as possible

ECMO http://www.cardiohelp.info/uploads/pics/3_3_schaubild_cardiohelp.jpg

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Interdisciplinary emergency medical care Emergency medical system (EMS) operator EMS team ECMO team operator ECMO team Heart Center with a catheterization lab and a surgery room

Interdisciplinary clinical pathway Cardiopulmonary resuscitation by bystanders Resuscitation by an EMS team Out-hospital ECMO implantation by an ECMO team Patient transport to the Heart Center with ECMO in their groin Specialized care in the Heart Center

Resuscitation by Bystanders Circulatory arrest Calling an EMS operator Resuscitation by bystanders Help by an EMS operator by telephone ECMO team operator activation, ECMO team activation Time zero – time at loss of consciousness Real time zero– time declared by witnesses Estimated time zero – time at loss consciousness without witnesses (estimation)

Professional Resuscitation Continuing professional resuscitation Repeated external defibrillations Breakpoint (BP) – 15? minutes after time zero without a successful resuscitation ECMO team departing to the place of resuscitation Chest compression with cooling aa. carotis (ice) no attempt at ROSC (return of spontaneous circulation), but only to maintain basal tissue perfusion (brain) Utilization of chest mechanical compression

Implantation of peripheral VA ECMO Implantation of VA ECMO into the groin by a skilled perfusionist Transport to the Heart Center

Specialized Heart Center PCI, CT Cardiac surgery procedure (CPB in the groin) ICU Attempts at Weaning Unsuccessful weaning – VAD implantation, Heart transplantation

Sudden cardiac arrest - athletes

Injuries - military service

Thanks for your attention