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

2. 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.

3. Jan Kaplicky Michael Jackson

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

5. 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)

6. 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

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

8. 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

9. 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

10. ECMO

12. 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

13. 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

14. 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)

15. 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

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

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

18. Sudden cardiac arrest - athletes

19. Injuries - military service

20. Thanks for your attention