The Use of Predictive Modeling to Compare Prehospital eCPR Strategies. (17th February 2023)

• Record Type: Journal Article
• Authors: Spigner, Michael; Braude, Darren; Pruett, Kimberly; Ortiz, Chris; Glazer, Joshua; Marinaro, Jonathan
• Is Part Of: Prehospital emergency care. Volume 27:Number 2(2023)
• Page Start: 184
• Page End: 191
• Publication Date: 2023-02-17
• Subjects: 362.18
• DOI: 10.1080/10903127.2022.2079782
• Languages: English
• ISSNs: 1090-3127

Abstract

Abstract: The duration of low flow prior to initiation of extracorporeal cardiopulmonary resuscitation (eCPR) appears to influence survival. Strategies to reduce the low-flow interval for out-of-hospital cardiac arrest have been focused on expediting patient transport to the hospital or initiating extracorporeal support in the prehospital setting. To date, a direct comparison of low-flow interval between these strategies has not been made. To attempt this comparison, a model was created to predict low-flow intervals for each strategy at different locations across the city of Albuquerque, New Mexico. The data, specific to Albuquerque, suggest that a prehospital cannulation strategy consistently outperforms an expedited transport strategy, with an estimated difference in low-flow interval of 34.3 to 37.2 minutes, depending on location. There is no location within the city in which an expedited transport strategy results in a shorter low-flow interval than prehospital cannulation. It would be rare to successfully initiate eCPR by either strategy in fewer than 30 minutes from the time of patient collapse. Using a prehospital cannulation strategy, the entire coverage area could be eligible for eCPR within 60 minutes of patient collapse. The use of predictive modeling can be a low-cost solution to assist with strategic deployment of prehospital resources and may have potential for real-time decision support for prehospital clinicians.