Over 200,000 people are treated for out-of-hospital cardiac arrest (OHCA) each year in the United States, and less than 1 in 10 survive with favorable neurologic function. Extracorporeal cardiopulmonary resuscitation (ECPR) using percutaneous veno-arterial extracorporeal circulation (VA-ECMO) is emerging as a potentially effective resuscitation strategy for OHCA patients who fail standard therapy. In published recent case series, survival rates range from 4-33%. Although promising, the efficacy of ECPR for OHCA has yet to be determined in a prospective randomized clinical trial. The overall goal of our research team is to design and perform the first prospective randomized clinical trial to evaluate the efficacy of ECPR for refractory OHCA. The goal of this NHLBI Clinical Trial Pilot Studies application is to generate the preliminary feasibility and efficacy data necessary and sufficient to design a full-scale clinical trial that will provide definitive guidance on the value of ECPR for refractory OHCA.
Our first Aim i s to demonstrate the efficacy of a training program designed to assure that emergency department providers can rapidly and safely initiate ECPR.
Our second Aim i s to evaluate the feasibility and performance of an EMS resuscitation strategy incorporating rapid identification and transport of patients with refractory OHCA to an ECPR-capable emergency department.
Our third Aim i s to evaluate the feasibility and performance of an ED protocol for initiating ECPR in patients with refractory OHCA.
Our final Aim i s to design and optimize an adaptive clinical trial that will maximize the performance of the planned Phase III multicenter study. The results of these aims will be used to prepare and submit a R01 application for a prospective randomized clinical trial to evaluate the efficacy of ECPR for Refractory Out-of- hospital Cardiac Arrest (EROCA Trial). The potential impact of such a trial is significant. Widespread implementation of ECPR for refractory OHCA could double overall survival rates, saving >10,000 lives each year in the United States. However, emergency medical systems, emergency departments and hospitals need evidence-based guidance regarding the value of implementing this promising but resource intensive therapy. The goal of our team is to provide the essential evidence needed to enable value-based implementation.

Public Health Relevance

Over 200,000 people are treated for out-of-hospital cardiac arrest (OHCA) each year in the United States, but less than 1 in 10 survive and return to normal function. The goal of this application is to study an alternative strategy to standard CPR called extracorporeal cardiopulmonary resuscitation (ECPR), which uses a machine outside the body to temporarily take over the work of heart and lungs until the heart can be restarted. Widespread implementation of ECPR for patients with OHCA who would otherwise die has the potential to save >10,000 lives each year in the United States.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Planning Grant (R34)
Project #
1R34HL130738-01A1
Application #
9182635
Study Section
Special Emphasis Panel (CLTR (MA))
Program Officer
Sopko, George
Project Start
2016-08-18
Project End
2018-05-31
Budget Start
2016-08-18
Budget End
2017-05-31
Support Year
1
Fiscal Year
2016
Total Cost
$348,750
Indirect Cost
$123,750
Name
University of Michigan Ann Arbor
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Haas, Nathan L; Coute, Ryan A; Hsu, Cindy H et al. (2017) Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-An ELSO registry study. Resuscitation 119:56-62
Sinha, Shashank S; Sukul, Devraj; Lazarus, John J et al. (2016) Identifying Important Gaps in Randomized Controlled Trials of Adult Cardiac Arrest Treatments: A Systematic Review of the Published Literature. Circ Cardiovasc Qual Outcomes 9:749-756