The University of Iowa Hospitals and Clinics has a new way to save people. The process called eCPR and is available starting today at the hospital.
Peter Georgakakos, an emergency medicine physician at the University of Iowa, explains how eCPR is being used at the hospital to save cardiac patients. “During the process of normal CPR being given, compressions are performed and then as indicated, medication ventilations and defibrillation. eCPR is an added tool that in the process of that resuscitation going on, a physician is cannulating or accessing the patient’s circulatory system to put them basically on cardiopulmonary bypass, to essentially take the heart and lungs out of it.”
“By taking the heart and lungs out of it, then the cardiologist can deal with the definitive problem that in these cases will be overwhelmingly, most commonly be some sort of plaque in the coronary arteries.”
Traditional CPR is still the best way to handle an immediate cardiac event. “When we’re doing compressions, what that’s doing is essentially trying to beat the heart for them to circulate blood,” said Georgakakos. “Obviously, our external compressions are never as efficient as our intrinsic heart’s ability to do so and so we’re doing the best we can for them by putting them on the ECMO machine.” The machine creates pressure that circulates the patient’s blood, puts oxygen in it and removes waste.
The main trial for eCPR came out of Minnesota and caught Georgakakos’ attention. “I was looking with some of my colleagues at our numbers in the county (Johnson County) and through our emergency department, and it just seemed like we had a fair number of patients who would have potentially benefited from this.” They only had one meeting about implementing eCPR before the project was derailed by COVID-19.
After about 18 months, the project got back on track and launched November 1. “We are uniquely equipped to be the first to launch this program in Iowa,” he said. “To launch a successful program like this, you need manpower, logistic support and incredible expertise.”
Not every cardiac patient is a candidate for eCPR or ECMO, said Georgakakos. “The patients that we’re gonna be doing this on are in what’s called refractory ventricular fibrillation. When patients go into cardiac arrest, they’re either in a shockable or in a non-shockable rhythm. That’s why it’s so important that we’re training the public on AED use because we want to shock them early,” he said. “Patients who are shocked in the first three minutes have up to an 80% survival rate and so it’s always just a race against the clock to get things going. When we get into these refractory ventricular fibrillation patients, their mortality goes up drastically because our normal measures aren’t working – compressions, defibrillation, the electricity, the medications are not changing things and eventually you hit this point where further interventions there are not helping.” These patients would be the ones eligible to try ECMO.
“When we get into the refractory D fib population, their mortality is much worse than the ‘typical’ cardiac arrest patient. Our intention here was to offer an intervention to this very small group of patients who otherwise are being declared dead who potentially are going to walk out of the hospital.” Georgakakos says they may not perform these procedures daily or even weekly, but it’s still available when necessary.
Not every hospital will be able to use eCPR. “Unfortunately, it is not going to be available at every hospital, just because it requires so many moving parts.” Only a few medical professionals have been trained on the method; 10 people at the hospital have the knowledge, skills and ability to help put somebody on ECMO.
For more information on eCPR at the University of Iowa Hospitals and Clinics, click here.