- Cardiac arrest is among the leading causes of death in BC and across Canada.
- In 2015, paramedics responded to 627 suspected cardiac arrests in Vancouver and North Vancouver.
- Only about 14 per cent of patients survive out-of-hospital cardiac arrests.
- Researchers hope to eventually triple that survival rate using this new therapy.
- ECMO-CPR funding came from a number of sources, including Providence Health Care Research Institute. U.S. medical-devices company Physio-Control Inc. has provided vital equipment for the trial.
When otherwise healthy 38-year old Genya Kaplun was found unresponsive, hypothermic, and without a pulse, he was brought to St. Paul’s Emergency Department where a team of quick-thinking doctors pulled out all of the stops, attempting a never-before tried combination of interventions, to save his life.
After two hours of being hooked up to the LUCAS machine – an electrically-powered device that provides chest compressions similar to what a paramedic – Genya’s heart started beating again.
A harrowing and life-changing event for any unsuspecting person to experience, cardiac arrest is surprisingly common – cited among the leading causes of death in BC and across Canada. In the year following Genya’s scare, paramedics responded to 627 suspected cardiac arrests in Vancouver and North Vancouver alone.
But because CPR cannot be effectively or safely delivered in a moving vehicle out-of-hospital cardiac arrest is a challenge.
Typically, paramedics treat cardiac arrest patients on-scene and if the patient couldn’t be revived, the patient wouldn’t get transported because the hospital had no additional therapies to offer. However, the availability of Extracorporeal Membrane Oxygenation –Cardiopulmonary Resuscitation (or, ECMO-CPR) therapy has changed all of that.
A second chance at survival
The night of Genya’s cardiac arrest, Dr. Joseph Finkler and the team of quick-thinking doctors at St. Paul’s scrambled to set up the LUCAS and ECMO machines, saving Genya from almost certain death.
Now formalized into a landmark trial, St. Paul’s Hospital and BC Emergency Health Services (BCEHS) teamed up in June 2016 to further test the BC Extracorporeal Cardiopulmonary Resuscitation Trial for Refractory Out of Hospital Cardiac (ECPR). This first-of-its-kind-in-Canada protocol is targeted at seemingly healthy people like Genya who suffer a sudden cardiac arrest outside of a hospital setting – a group of patients whose previous survival rate was 14 per cent.
Prior to the ECPR trial, the survival rate for patients who experienced cardiac arrest outside of a hospital was 14%
“ECMO is essentially an external heart that pushes blood around the body, pumping the patient’s blood through the body, organs and brain and restoring blood flow in a patient who has been unable to get a pulse back from ongoing CPR,” explains Dr. Brian Grunau, BC ECPR Study Principle Investigator, Department of Emergency Medicine at St. Paul’s Hospital. “We can now initiate them on ECMO to get the blood flowing again, which then gives us a chance to reverse the cause that caused the cardiac arrest.”
It takes a village
Highly reliant on rapid, coordinated response with specially trained paramedics and the cardiac team, the trial first sees paramedics fitting the LUCAS system to a patient who has suffered cardiac arrest in order to provide continuous, high-quality compressions while being transported in the ambulance. Using the automatic machine allows paramedics to focus on providing advanced cardiac care, monitoring the patient and getting to the hospital quickly.
Upon arrival at St. Paul’s, the patient is met by a multidisciplinary clinical team that initiates the life-saving ECMO-CPR therapy. The team attaches the patient to the ECMO machine, an external pump that does the job of a patient’s heart and lungs, while doctors work to fix what caused the arrest.
The goal is to get the patient to St. Paul’s Hospital and started on ECMO within 60 minutes of initiation of CPR by first responders.
“The Emergency Physician on shift that night made the decision to put this together and decided to bring me in, rather than leave me unconscious on the scene because I couldn’t be revived. If everything went the way things typically go for patients like me, I definitely would have been dead,” says Genya, who was back to work six weeks after his brush with death. “I take a pause and look around, and am thankful to be here, for sure.”