Table 2.
Results of MMRC process characteristics, performance metrics, and benchmarks.
| Characteristic/Performance Metric/Benchmark | Value |
|---|---|
| 10 EMS Agencies | |
| Accuracy of ECMO-facilitated Resuscitation Patient Selection [N, (%)] | 58/63 (92%) |
| 911 to first responder arrival (minutes) | 7.2 ± 3.6 |
| EMS On-Scene time (minutes; benchmark < 15 min) | 22.0 ± 8.9 |
| 911 to patient arrival at ED (minutes) | 46.9 ± 12.3 |
| Public Location [N, (%)] | 18/58 (31%) |
| Bystander witnessed [N, (%)] | 42/58 (72%) |
| Bystander /Dispatched Assisted CPR [N, (%)] | 32/58 (55%) |
| Out-of-Hospital Airway [N, (%)] | |
| Bag-valve-mask only | 6/58 (10%) |
| Supraglottic Airway | 22/58 (38%) |
| Endotracheal Intubation | 30/58 (52%) |
| Epinephrine doses (1 mg) | 3.4 ± 0.7 |
| Amiodarone (mg dose) | 387 ± 75 |
| Number of shocks by EMS | 5.3 ± 2.1 |
| Intermittent ROSC prior to ED arrival [N, (%)] | 16/58 (28%) |
| ECMO Initiation Hospitals | |
| 1 N (%) | 19/58 (33%) |
| 2 N (%) | 25/58 (43%) |
| 3 N (%) | 14/58 (24%) |
| Perfusion Discontinuation Criteria on ECMO Initiation Hospital Arrival | |
| Initial lactic Acid (mmol/L) | 12.5 ± 4.2 |
| Initial pH | 6.98 ± 0.21 |
| Initial arterial oxygen, PaO2, (mm Hg) | 87 ± 109 |
| Initial serum bicarbonate, mg/dL | 16.3 ± 5.6 |
| End Tidal CO2 (%) | 35 ± 16 |
| Proportion of patients meeting discontinuation criteria [N, (%)] | 13/58 (22%) |
| Mobile ECMO Cannulation Team | |
| Response time to ED (mean, minutes; benchmark < 15 min) | 14.9 ± 5.7 |
| Number of Safe Responses [N, (%)] | 63/63 (100%) |
| Patient ED Arrival to ECMO Cannulation (mean, minutes; benchmark < 15 min) | 14.4 ± 6.1 |
| Duration of Patient Professional CPR (minutes; benchmark < 60 min) | 52.2 ± 17.0 |
| Cannulation success rate [N, (%)] | 45/45 (100%) |
| Cannulation complication rate [N, (%)] | 0/45 (0%) |
| Cardiac Catheterization Laboratory (CCL) | |
| 911 to Cardiac Catheterization Lab Time (mean; min; benchmark < 120 min) | 121 ± 56 |
| Angiography performed [N, (%)] | 45/58 (78%) |
| Presence of severe coronary artery disease [N, (%)] | 29/45 (64%) |
| Percutaneous coronary intervention performed [N, (%)] | 22/29 (85%) |
| Culprit vessel [Number, (%) of Patients] | |
| Left main coronary artery | 2/45 (4%) |
| Left anterior descending | 12/45 (27%) |
| Left circumflex | 0/45 (0%) |
| Right coronary artery | 8/45 (18%) |
| Chronic total occlusions | 10/45 (22%) |
| Total stents placed in all vessels (mean) | 1.8 ± 1.2 |
| Transport to ECMO Intensive Care Unit | |
| Number of transports without adverse events [N, (%)] | 41/41 (100%) |
| Centralized ECMO Intensive Care Unit | |
| Therapeutic Hypothermia Provided (24 h; goal temperature 34 °C) [N, (%)] | 41/41 (100%) |
| 24-hour LVEF on echocardiogram in ICU (%) | 13 ± 13 |
| LVEF on hospital discharge (%) | 51 ± 14 |
| Tracheostomy [N, (%)] | 5/41 (12%) |
| Percutaneous endoscopic gastrostomy tube [N, (%)] | 5/41 (12%) |
| ECMO-Related Complications | |
| Circuit thrombosis [N, (%)] | 0/45 (0%) |
| Air-embolism [N, (%)] | 0/45 (0%) |
| Access site bleeding requiring >3 units PRBCs [N, (%)] | 4/45 (9%) |
| Ischemic Limb requiring intervention (fasciotomy, amputation) [N, (%)] | 0/45 (0%) |
| Circuit failure (increased transmembrane resistance) [N, (%)] | 1/45 (2%) |
| Time to Decannulation, days | |
| Survivors | 4.2 ± 1.5 |
| Non-survivors | – |
| Time to Extubation, days | |
| Survivors | 10.2 ± 7.5 |
| Non-survivors | – |
| Length of ICU Stay, days | |
| Survivors | 15.1 ± 8.1 |
| Non-survivors | 7.0 ± 13 |
| Hospital Length of Stay, days | |
| Survivors | 18.9 ± 8.6 |
| Non-survivors | 7.0 ± 13 |
| Outcomes | |
| Survival to hospital discharge [N, (%)] | 27/58 (47%) |
| Functionally favorable survival to hospital discharge (CPC 1 or 2) [N, (%), CI] | 25/58 (43% [CI: 31–56%]) |
| Survival to 3 months | 25/58 (43%) |
| Functionally favorable 3-month survival (CPC 1 or 2) [N, (%), CI] | 25/58 (43% [CI: 31–56%]) |
| HOSPITAL DISCHARGE Cerebral Performance Category (mean; N = 27) | 1.6 ± 0.7 |
| CPC 1 | 12/58 (21%) |
| CPC 2 | 13/58 (22%) |
| CPC 3 | 0/58 (0%) |
| CPC 4 | 2/58 (3%) |
| CPC 5 | 31/58 (54%) |
| 3-MONTH Cerebral Performance Category (mean; N = 27) | 1.3 ± 0.7 |
| CPC 1 | 19/58 (33%) |
| CPC 2 | 6/58 (10%) |
| CPC 3 | 0/58 (0%) |
| CPC 4 | 2/58 (3%) |
| CPC 5 | 31/58 (54%) |
Table 2: MMRC Process Characteristics, Performance Metrics, and Benchmarks. Values are n (%) or mean ± standard deviation. MMRC = Minnesota Mobile Resuscitation Consortium EMS = Emergency Medical Service, ECMO = Extracorporeal Membrane Oxygenation, ED = Emergency Department,; mmol = millimoles; L = liter; pH = potential of hydrogen; PaO2 = partial pressure of oxygen in arterial blood; mmHg = millimeters of mercury; O2Sat = oxygen saturation; ETCO2 = end-tidal carbon dioxide; EIH = ECMO Initiation Hospital; CPR= cardiopulmonary resuscitation; CCL = Cardiac Catheterization Laboratory, PRBCs= packed red blood cells; CPC = Cerebral Performance Category; CI = Confidence Interval.