Abstract 16365: Access to Extracorporeal Membrane Oxygenation Centers for Cardiac Arrest
Introduction: Utilization of extracorporeal membrane oxygenation (ECMO) in OHCA (E-CPR) is increasing. This therapy can extend the therapeutic window to correct the etiology of OHCA by reperfusing vital organs, but its success is extremely time-sensitive. By definition, an E-CPR candidate must be in reasonable proximity to necessary resources. It is unknown how much of the US population resides within geographic areas that have access to E-CPR.
Purpose: Estimate the US population that could reasonably access hospitals capable of E-CPR.
Methods: We geocoded ECMO centers in the lower 48 states that participate in the Extracorporeal Life Support Organization (ELSO) and plotted 45-min drive time isochrones calculated with coordinated average drive speed around each hospital, representing the distance that could be reasonably covered by ground EMS transporting a cardiac arrest patient. We selected 45 min to maximize the geographic catchment area with a best case scenario of rapid candidate identification and E-CPR deployment (evidence-based convention of maximum collapse-to-ECPR interval is < 1 hour). The isochrones were then overlaid on a 2010 US population raster map to estimate the proportion of covered population. We also estimated the annual incidence of OHCA inside and outside of the isochrones based on AHA Heart Disease and Stroke Statistics Update.
Results: A total of 104,359,381 persons reside within the 45-min isochrone areas (37.3% of US population). Extrapolating the annual incidence of OHCA, 131,910 OHCA cases/year occur within feasible EMS drive time of an ECMO/E-CPR center, and 221,483 OHCA cases/year do not.
Conclusion: One third of the US population resides within a feasible distance for EMS ground transport to an E-CPR capable hospital. Prehospital cardiac arrest protocols should be locally tailored to this consideration. More widespread ECMO use or alternative E-CPR deployment strategies may expand the availability of this therapy.
Author Disclosures: C. Wilson: None. J. Reynolds: None. M.W. Dailey: None. N. Rathert: None. A. Frisch: None.
- © 2016 by American Heart Association, Inc.