Impact of an eCPR Pilot Program on Outcomes After Out-of-Hospital Cardiac Arrest for Patients Who Do Not Receive eCPR in a Large, Urban EMS System

OBJECTIVES: Los Angeles County initiated an extracorporeal cardiopulmonary resuscitation (eCPR) program to transport patients with refractory shockable out-of-hospital cardiac arrest (OHCA) to dedicated eCPR-capable centers (ECCs). The impact of an eCPR program on patients with OHCA who do not receive eCPR has not been described. METHODS: We measured the association between EMS unit participation in the program and survival-to-hospital discharge for patients with OHCA who did not receive eCPR, treated between July 2019 and September 2023. Six of the 29 EMS agencies participated in the program, which included eCPR protocol development, hands-on scenario-based training on the eCPR protocol and application of the mechanical compression device (MCD) on a manikin, and provision of MCDs. Because the deployment model for one agency differed from others (MCDs on supervisor units, no paramedic hands-on training), we prespecified a subgroup analysis excluding that agency. RESULTS: We analyzed 30,855 patients with EMS-treated OHCA: 7% had a shockable rhythm, 32% were treated by a pilot unit pre-implementation, 24% by a pilot unit post-implementation, and 44% were treated by a unit that never participated in the eCPR pilot. Treatment by a pilot unit post-implementation was not associated with a significant difference in the odds of survival-to-discharge compared to pre-implementation (1.14 95%CI 0.99-1.34) in the primary analysis but was associated with it in the subgroup analysis (1.61 95%CI 1.37-1.95). Similar results were found for neurologic outcome at discharge. CONCLUSIONS: Implementation of an eCPR program is not associated with worse outcomes for patients with OHCA who did not receive eCPR and may be associated with benefit depending on implementation.