Impact of an extracorporeal CPR program on out-of-hospital cardiac arrest ambulance arrivals to an academic center emergency department

Objectives Extracorporeal cardiopulmonary resuscitation (ECPR) has seen increasing use globally as a life-saving intervention for patients with refractory cardiac arrest, including those suffering out-of-hospital cardiac arrests (OHCA) transported to the Emergency Department (ED). ECPR requires extensive resource commitment and outcome data for OHCA patients transported to ECPR capable EDs remain limited. The objective of this study was to evaluate the association of implementing an ED ECPR program on OHCA ambulance arrivals to an academic medical center ED. Methods We conducted a before-after study at an urban, academic, level 1 trauma, and STEMI-receiving center ED (annual census approximately 50,000). The regional county Emergency Medical Services (EMS) agency (population 3.1 million) initiated an ECPR pilot program to direct Advanced Life Support (ALS) 911 transports of refractory OHCA patients to a limited number of designated as ECPR receiving centers (i.e., ECPR-capable EDs). We analyzed ECPR, OHCA, and total ALS 911 EMS ED transports in the 6 months before (July–Oct 2024, pre-ECPR) and 6 months following (Dec 2024–May 2025, ECPR) county EMS agency designation as an ECPR receiving center. The implementation month, November, was excluded from all analyses. In addition, we compared these 6-month periods with the 6-month period 1 year prior to the implementation (July–Oct 2023, pre1y-ECPR). The number of OHCA per 1,000 ALS transports was compared for each of the three time periods using descriptive statistics and Fisher's exact testing as indicated, with a p < 0.05 considered statistically significant. Results After ECPR designation, there was an increase in OHCA transports compared with both the pre-ECPR and pre1y-ECPR periods (7.8 vs. 3.2 vs. 3.5 per 1,000 ALS transports, respectively, p < 0.05). Of note, only eight OHCA patients transported to the ED in the ECPR period met the County ECPR criteria, and only one was placed on veno-arterial extracorporeal membrane oxygenation. Conclusion Inclusion into a county wide ED ECPR program for refractory OHCA resulted in a significant increase in the number of OHCA and ALS transports to an academic medical center ED, even though many of these patients did not actually meet pre-determined criteria for ECPR activation from the field.